Esophagus

Other tumors

Melanoma



Last author update: 20 October 2022
Last staff update: 20 October 2022

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PubMed Search: Esophageal melanoma

Yukihiro Nakanishi, M.D., Ph.D.
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Page views in 2022 to date: 14,938
Cite this page: Nakanishi Y. Melanoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/esophagusmelanoma.html. Accessed December 7th, 2022.
Definition / general
  • Primary malignant melanoma developing from the esophageal mucosa / melanocyte
Essential features
  • Middle aged to elderly patients, with male predominance
  • Protruding tumor with pigmentation / black discoloration in the middle or lower esophagus
  • Epithelioid or spindle melanoma cells with junctional melanocytic activity / junctional melanocytic component
  • Aggressive tumor
Terminology
  • Primary malignant melanoma of the esophagus
ICD coding
  • ICD-10: C15.9 - malignant neoplasm of the esophagus, unspecified
Epidemiology
Sites
Clinical features
Diagnosis
  • Biopsy with immunohistochemistry
Radiology description
Radiology images

Contributed by Yukihiro Nakanishi, M.D., Ph.D.
Elevated lesion

Elevated lesion

Prognostic factors
Case reports
Treatment
  • Surgical resection
  • Endoscopic resection
  • Immunotherapy (PD-1 inhibitor systemic treatment) (Thorac Cancer 2019;10:950)
  • Chemotherapy
  • Targeted therapy
Clinical images

Contributed by Yukihiro Nakanishi, M.D., Ph.D.
Protruding mass

Protruding mass

Gross description
Gross images

Contributed by Yukihiro Nakanishi, M.D., Ph.D.
Protruding mass

Protruding mass

Microscopic (histologic) description
  • Mostly epithelioid tumor cells with at least focal melanin pigment (Mod Pathol 2019;32:957)
  • Associated melanoma in situ component (junctional melanocytic activity / junctional melanocytic component / tumor nests at the epithelium - lamina propria junction / horizontal tumor spread in the basal layer of the epithelium) and melanocytosis / melanosis (Mod Pathol 2019;32:957, Ann Thorac Surg 2013;96:1002)
Microscopic (histologic) images

Contributed by Yukihiro Nakanishi, M.D., Ph.D. and @RaulSGonzalezMD on Twitter
Protruding mass

Protruding mass

Prominent nucleoli

Prominent nucleoli

Melanoma

Melanoma

Melanoma

Melanoma

Melanoma

Melanoma

Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Esophagus, mass, biopsy:
    • Malignant melanoma (see comment)
    • Comment: The infiltrating epithelioid tumor cells are positive for S100, HMB45, MelanA and negative for AE1 / AE3, CAM5.2, synaptophysin and chromogranin. The morphology and immunoprofile are consistent with malignant melanoma.
Differential diagnosis
Board review style question #1

Which of the following is true about primary malignant melanoma of the esophagus?

  1. Junctional melanocytic activity suggests a primary malignant melanoma of the esophagus
  2. Melanin pigments should be always found in the tumor cells by definition
  3. No melanocytes are found in the normal esophagus
  4. SOX10 is a useful marker to differentiate benign nevi from malignant melanomas
Board review style answer #1
A. Junctional melanocytic activity (shown in the picture) suggests a primary malignant melanoma of the esophagus

Comment Here

Reference: Esophageal melanoma
Board review style question #2
Which of the following is true about primary malignant melanoma of the esophagus?

  1. BRAF mutation is the most common mutation, as in cutaneous melanoma
  2. Cervical esophagus is the most common site
  3. Most cases show protruding lesions
  4. Smoking and alcohol consumption are important risk factors
  5. Usually seen in young female patients
Board review style answer #2
C. Most cases show protruding lesions

Comment Here

Reference: Esophageal melanoma
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