Journal of Gastroenterology

, Volume 47, Issue 1, pp 21–28 | Cite as

Current status of primary malignant melanoma of the esophagus: clinical features, pathology, management and prognosis

  • Yoshimi IwanumaEmail author
  • Natsumi Tomita
  • Takayuki Amano
  • Fuyumi Isayama
  • Masahiko Tsurumaru
  • Takuo Hayashi
  • Yoshiaki Kajiyama


Primary malignant melanoma of the esophagus (PMME) is a rare disease with an extremely poor prognosis. Up to 2011, approximately 300 cases had been reported worldwide. The average age of onset is 60.5 years old, with a prevalence of males (2:1). A typical finding of PMME is a lobular or polyploid, well-circumscribed and pigmented tumor, partly covered with normal mucosa. PMME represents various colors depending on its melanin quantity and commonly coexists with intramural metastases, melanocytosis or melanoma in situ. The tumor is located from the middle to lower thoracic esophagus. The accuracy of diagnosis from biopsy is approximately 80%, because many cases are misdiagnosed as a poorly differentiated carcinoma because of the absence of melanin granules. A definite diagnosis was made by immunohistochemical examination with positive results of S100 protein, HMB45 and neuron-specific enolase. PMME has a highly metastatic potential, and the incidence of distant metastasis at the initial diagnosis is around 40–80%. A metastatic tumor from cutaneous malignant melanoma is another pigmented esophageal tumor to be considered when making the differential diagnosis for PMME. Junctional activity with melanotic cells in the adjacent epithelium and the presence of in situ melanoma and/or a satellite tumor without a previous history of cutaneous melanoma are definitive. Most of the reported patients were treated with radical esophagectomy, which is believed to be an effective approach for localized PMME. Five-year survival rates have been achieved in 37% recently, while adjuvant therapy has not been proven to increase overall survival but plays a palliative role.


Primary malignant melanoma of the esophagus Metastatic malignant melanoma Radical esophagectomy 



The authors express sincere thanks to M. Matsukawa and M. Swart for technical assistance and cooperation.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer 2011

Authors and Affiliations

  • Yoshimi Iwanuma
    • 1
    Email author
  • Natsumi Tomita
    • 1
  • Takayuki Amano
    • 1
  • Fuyumi Isayama
    • 1
  • Masahiko Tsurumaru
    • 2
  • Takuo Hayashi
    • 3
  • Yoshiaki Kajiyama
    • 1
  1. 1.Department of Esophageal and Gastroenterological SurgeryJuntendo University School of MedicineTokyoJapan
  2. 2.Cancer CenterJuntendo University School of MedicineTokyoJapan
  3. 3.Department of Human PathologyJuntendo University School of MedicineTokyoJapan

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