Abstract

We made a diagnosis as a malignant melanoma and conducted esophagectomy. She had DAC-Tam as a palliative chemotherapy after detecting recurrence. But she had wasted away and died within 14 months being diagnosed with her disease. Histological findings revealed malignant melanoma arise from esophagus with liver metastasis. She had nivolumab as first line therapy and ipilimumab subsequently, but she had wasted away and died within 6 months being diagnosed with her disease. Esophageal melanoma was very rare disease. Development of immune-check inhibitor and molecular targeting therapy changed the prognosis for patients.

Case-1

A 57-year-old woman was admitted with a complaint of fatigue and anemia (serum hemoglobin, 5.6 g/dl). We detected an irregular tumor 4 cm in diameter in the lower esophagus, using an upper endoscopic test; melanosis was detected near the tumor. An esophageal biopsy revealed large tumor cells possessing minimal cytoplasm and hyperchromatic indistinct nucleoli based on Hematoxylin and Eosin (HE) staining. We performed esophagectomy and the final staging, on histopathological examination, was IIIA (UICC-6). She was administered DAV-Feron (DTIC, ACNU, VCR and Interferonβ) as adjuvant chemotherapy. However, she was diagnosed with recurrence of the melanoma in the peritoneum in March 2010. We initiated DAM-Tam (DTIC, ACNU, CDDP and tamoxifen) as palliative chemotherapy. She had grade 3 neutropenia and grade 2 fatigues, but these adverse events were controlled to reduce dose settings. She progressively weakened and died within 14 months of being diagnosed with the disease.

Case-2

A 67-year-old woman visited complaining of fatigue. A type 1 tumor with blue pigment deposition in the lower esophagus was detected on upper endoscopy and liver metastasis was observed using Positron Emission Tomography-Computed Tomography (PET-CT). An esophageal biopsy revealed large tumor cells possessing minimal cytoplasm and hyperchromatic indistinct nucleoli based on HE staining. Immunostaining revealed that the tumor cells were positive for S-100 and Melan A, and negative for HMB-45. Histological findings revealed malignant melanoma that had arisen from the esophagus. We initiated nivolumab therapy based on the negative results of the B-RAF V600E mutational test. She exhibited no adverse events after the administration of nivolumab. However, CT revealed progression of the disease within 3 months. We changed to ipillimumab. However, she progressively weakened and died within 6 months of being diagnosed with the disease. Esophageal melanoma was very rare disease. Development of immune-check inhibitor and molecular targeting therapy changed the prognosis for patients.

Keywords: Melanoma; Esophageal cancer; Molecule targeting therapy; Immune-check point inhibitor