Primary malignant melanoma of the esophagus

Three cases of primary malignant melanoma of the esophagus are presented with emphasis on the gross and histopathologic features. Grossly, the tumors tended to be polypoid with a smooth predominantly intact overlying mucosa. Microscopically a junctional lentiginous growth pattern was characteristic as well as a tendency to expand and fill the submucosa without invading the muscularis. A given tumor invariably was more extensive than grossly suspected and the lateral junctional spread was striking in two of the cases. Primary malignant melanoma should be included in the preoperative differential diagnosis of radiographically unusual esophageal tumors, particularly if the lesion is polypoid. Because of the potentially widespread intramucosal component, surgical treatment of esophageal melanoma required a radical procedure with a far greater margin than for the usual squamous cell carcinoma. Intracavitary radiotherapy may be a useful form of adjuvant therapy in selected patients.