Primary Melanoma of the Oesophagus: A Case Report and Review of the Literature

Background Primary melanoma of the oesophagus is rare, and there is a paucity of evidence to guide treatment decisions. Traditionally, treatment has included surgery, chemotherapy and/or radiotherapy. The advent of immunotherapy revolutionized the treatment of cutaneous melanoma, however molecular studies have provided conflicting results regarding whether the underlying mechanisms driving melanoma response to immunotherapy are reproduced in mucosal and more specifically oesophageal melanomas. The evidence base for treatment decisions in primary malignant melanoma of the oesophagus remains limited. Methods We present the case of a patient diagnosed with metastatic oesophageal melanoma who was treated with immunotherapy. Narrative review of the literature was then performed in order to identify prior reported cases of oesophageal melanoma and review their management. Results An 81-year-old Caucasian female presented with dysphagia and proceeded to CT and endoscopy showing a large mid to distal oesophageal mass. Endoscopic biopsies revealed a poorly differentiated epithelioid malignancy, with immunohistochemical studies confirming melanoma. FDG-PET revealed metastatic deposits in the skeleton as well as mesenteric nodes. The patient was commenced on treatment with ipilimumab and nivolumab 18 days following diagnosis, and demonstrated remarkable resolution of local symptoms as well as complete resolution of PET-avidity of all local and metastatic disease. Literature search identified 15 cases of patients with oesophageal melanoma. Conclusion We report our experience with a rare case of metastatic oesophageal melanoma treated with immunotherapy, with encouraging results. We would encourage reporting of further cases in order to better understand the role of immunotherapy in oesophageal melanoma.