A case of primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus (PMME) is an extremely rare esophageal malignancy that is often misdiagnosed or overlooked due to its atypical symptoms. We report a case of a 75-year-old male patient who presented with progressive dysphagia. Endoscopic examination revealed a black mass located 25 cm from the incisors. Further imaging studies, including computed tomography (CT) and emission computed tomography (ECT), showed significant thickening of the mid-esophageal wall with localized soft tissue mass formation and heterogeneous enhancement on contrast scans. Multiple lymph nodes around the lesion were visible, leading to an initial misdiagnosis of esophageal cancer. Additionally, metabolic abnormalities in the left scapula suggested possible bone metastasis of the tumor. The final pathological diagnosis was esophageal melanoma. After thorough evaluation of the patient's medical history and additional relevant tests, the primary origin was considered. Diagnosing primary malignant melanoma of the esophagus is a challenging task. This case, through the combination of endoscopic examination, imaging, and pathology, illustrates the characteristics of PMME, providing important insights for clinicians and emphasizing the necessity of comprehensive early evaluation to improve diagnostic accuracy and treatment outcomes.