Abstract
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.
Similar content being viewed by others
References
Baur EH. Ein Fall von Primaerem Melanoma de Oesophagus. Arb Geb Pathol Anat Inst Tuebingen. 1906;5:343–54.
Volpin E, Sauvanet A, Couvelard A, Belghiti J. Primary malignant melanoma of the esophagus: a case report and review of the literature. Dis Esophagus. 2002;15:244–9.
Bisceglia M, Perri F, Tucci A, Tardio M, Panniello G, Vita G, et al. Primary malignant melanoma of the esophagus: a clinicopathologic study of a case with comprehensive literature review. Adv Anat Pathol. 2011;18:235–52.
Yamazaki K, Ohmori T, Kumagai Y, Makuuchi H, Eyden B. Ultrastructure of oesophageal melanocytosis. Virchows Arch A Pathol Anat Histopathol. 1991;418:515–22.
Ohashi K, Kato Y, Kanno J, Kasuga T. Melanocytes and melanosis of the oesophagus in Japanese subjects—analysis of factors effecting their increase. Virchows Arch A Pathol Anat Histopathol. 1990;417:137–43.
Maekawa T, Satoh K, Maekawa H, Wada R, Matsumoto M. A case of primary malignant melanoma arising in the esophagus. Nippon Gekakei Rengo Gakkai Zasshi. 2005;30:154–9.
Sabanathan S, Eng J, Pradhan GN. Primary malignant melanoma of the esophagus. Am J Gastroenterol. 1989;84:1475–81.
Chalkiadakis G, Wihlm JM, Morand G, Weill-Bousson M, Witz JP. Primary malignant melanoma of the esophagus. Ann Thorac Surg. 1985;39:472–5.
Japan Esophageal Society. Japanese Classification of Esophageal Cancer, tenth edition: part I. Esophagus. 2009;6:1–25.
Taniyama K, Suzuki H, Sakuramachi S, Toyoda T, Matsuda M, Tahara E. Amelanotic malignant melanoma of the esophagus: case report and review of the literature. Jpn J Clin Oncol. 1990;20:286–95.
Joob AW, Haines GK 3rd, Kies MS, Shields TW. Primary malignant melanoma of the esophagus. Ann Thorac Surg. 1995;60:217–22.
Kato N, Kamino K, Yamashita T, Umeyama K, Mitsuhashi T. Primary malignant melanoma of the esophagus. Gan No Rinsho. 1986;32:1459–65.
DiCostanzo DP, Urmacher C. Primary malignant melanoma of the esophagus. Am J Surg Pathol. 1987;11:46–52.
Lohmann CM, Hwu WJ, Iversen K, Jungbluth AA, Busam KJ. Primary malignant melanoma of the oesophagus: a clinical and pathological study with emphasis on the immunophenotype of the tumours for melanocyte differentiation markers and cancer/testis antigens. Melanoma Res. 2003;13:595–601.
Li B, Lei W, Shao K, Zhang C, Chen Z, Shi S, et al. Characteristics and prognosis of primary malignant melanoma of the esophagus. Melanoma Res. 2007;17:239–42.
Crippa F, Leutner M, Belli F, Gallino F, Greco M, Pilotti S, et al. Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med. 2000;41:1491–4.
Horowitz M, Nobrega MM. Primary anal melanoma associated with melanosis of the upper gastrointestinal tract. Endoscopy. 1998;30:662–5.
Walter A, van Rees BP, Heijnen BH, van Lanschot JJ, Offerhaus GJ. Atypical melanocytic proliferation associated with squamous cell carcinoma in situ of the esophagus. Virchows Arch. 2000;437:203–7.
Dumas O, Barthelemy C, Billard F, Dumollard JM, Boucheron S, Calmard P, et al. Isolated melanosis of the esophagus: systematic endoscopic diagnosis. Endoscopy. 1990;22:94–5.
Sharma SS, Venkateswaran S, Chacko A, Mathan M. Melanosis of the esophagus. An endoscopic, histochemical, and ultrastructural study. Gastroenterology. 1991;100:13–6.
Chang F, Deere H. Esophageal melanocytosis morphologic features and review of the literature. Arch Pathol Lab Med. 2006;130:552–7.
Mills SE, Cooper PH. Malignant melanoma of the digestive system. Pathol Annu. 1983;18(Pt 2):1–26.
Scotto J, Fraumeni JF Jr, Lee JA. Melanomas of the eye and other noncutaneous sites: epidemiologic aspects. J Natl Cancer Inst. 1976;56:489–91.
Dasgupta TK, Brasfield RD. Metastatic melanoma of the gastrointestinal tract. Arch Surg. 1964;88:969–73.
Sanchez AA, Wu TT, Prieto VG, Rashid A, Hamilton SR, Wang H. Comparison of primary and metastatic malignant melanoma of the esophagus: clinicopathologic review of 10 cases. Arch Pathol Lab Med. 2008;132:1623–9.
Allen AC, Spitz S. Malignant melanoma; a clinicopathological analysis of the criteria for diagnosis and prognosis. Cancer. 1953;6:1–45.
Lerut T, Nafteux P, Moons J, Coosemans W, Decker G, De Leyn P, et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg. 2004;240:962–72 (discussion 72–4).
Miyatani H, Yoshida Y, Ushimaru S, Sagihara N, Yamada S. Slow growing flat-type primary malignant melanoma of the esophagus treated with cap-assisted EMR. Dig Endosc. 2009;21:255–7.
Suzuki H, Nagayo T. Primary tumors of the esophagus other than squamous cell carcinoma—histologic classification and statistics in the surgical and autopsied materials in Japan. Int Adv Surg Oncol. 1980;3:73–109.
Hamdy FC, Smith JH, Kennedy A, Thorpe JA. Long survival after excision of a primary malignant melanoma of the oesophagus. Thorax. 1991;46:397–8.
Khoury-Helou A, Lozac’h C, Vandenbrouke F, Lozac’h P. Primary malignant melanoma of the esophagus. Ann Chir. 2001;126:557–60.
Uetsuka H, Naomoto Y, Fujiwara T, Shirakawa Y, Noguchi H, Yamatsuji T, et al. Primary malignant melanoma of the esophagus: long-term survival following pre- and postoperative adjuvant hormone/chemotherapy. Dig Dis Sci. 2004;49:1646–51.
Suehs OW. Malignant melanoma of the esophagus. Trans Annu Meet Am Bronchoesophagol Assoc. 1961;41:86–93.
De Mik JI, Kooijman CD, Hoekstra JB, Tytgat GN. Primary malignant melanoma of the oesophagus. Histopathology. 1992;20:77–9.
Gupta V, Kochhar R, Sinha SK, Das A. Primary malignant melanoma of the esophagus: long-term survival after radical resection. J Thorac Oncol. 2009;4:1180–2.
Cheung MC, Perez EA, Molina MA, Jin X, Gutierrez JC, Franceschi D, et al. Defining the role of surgery for primary gastrointestinal tract melanoma. J Gastrointest Surg. 2008;12:731–8.
Saba HI, Cruse CW, Wells KE, Klein CJ, Reintgen DS. Treatment of stage IV malignant melanoma with dacarbazine, carmustine, cisplatin, and tamoxifen regimens: a University of South Florida and H. Lee Moffitt Melanoma Center Study. Ann Plast Surg. 1992;28:65–9.
McClay EF, Mastrangelo MJ, Berd D, Bellet RE. Effective combination chemo/hormonal therapy for malignant melanoma: experience with three consecutive trials. Int J Cancer. 1992;50:553–6.
Del Prete SA, Maurer LH, O’Donnell J, Forcier RJ, LeMarbre P. Combination chemotherapy with cisplatin, carmustine, dacarbazine, and tamoxifen in metastatic melanoma. Cancer Treat Rep. 1984;68:1403–5.
Lens MB, Eisen TG. Systemic chemotherapy in the treatment of malignant melanoma. Expert Opin Pharmacother. 2003;4:2205–11.
Kirkwood JM, Ibrahim JG, Sondak VK, Richards J, Flaherty LE, Ernstoff MS, et al. High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. J Clin Oncol. 2000;18:2444–58.
Kyte JA, Gaudernack G, Dueland S, Trachsel S, Julsrud L, Aamdal S. Telomerase peptide vaccination combined with temozolomide: a clinical trial in stage IV melanoma patients. Clin Cancer Res. 2011;17:4568–80.
Kluger HM, Dudek AZ, McCann C, Ritacco J, Southard N, Jilaveanu LB, et al. A phase 2 trial of dasatinib in advanced melanoma. Cancer. 2011;117:2202–8.
Robert C, Thomas L, Bondarenko I, O’Day S, Weber J, Garbe C, et al. Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med. 2011;364:2517–26.
Alexandrescu DT, Ichim TE, Riordan NH, Marincola FM, Di Nardo A, Kabigting FD, et al. Immunotherapy for melanoma: current status and perspectives. J Immunother. 2010;33:570–90.
Kottschade LA, Suman VJ, Amatruda T 3rd, McWilliams RR, Mattar BI, Nikcevich DA, et al. A phase II trial of nab-paclitaxel (ABI-007) and carboplatin in patients with unresectable stage IV melanoma: a North Central Cancer Treatment Group Study, N057E(1). Cancer. 2011;117:1704–10.
Kirkwood JM, Gonzalez R, Reintgen D, Clingan PR, McWilliams RR, de Alwis DP, et al. A phase 2 study of tasisulam sodium (LY573636 sodium) as second-line treatment for patients with unresectable or metastatic melanoma. Cancer. 2011.
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Iwanuma, Y., Tomita, N., Amano, T. et al. Current status of primary malignant melanoma of the esophagus: clinical features, pathology, management and prognosis. J Gastroenterol 47, 21–28 (2012). https://doi.org/10.1007/s00535-011-0490-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-011-0490-y