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Primary malignant melanoma of the esophagus (PMME) is a rare neoplasm. The primary nature of esophageal melanoma has been questioned in the past because most reported cases have not been able to demonstrate local tumorigenesis or evolution of the malignancy from a preceding benign lesion or cell. In addition, the occurrence of metastatic melanoma to the esophagus is much more common than PMME.We report a case of PMME with separate foci of melanoma in situ and atypical melanocytic hyperplasia in a patient with human immunodeficiency virus infection. To our knowledge, this is the first reported case of PMME in a patient with a previous diagnosis of human immunodeficiency virus infection. In addition to adding data to the limited literature on this subject, we also provide histologic evidence that demonstrates the primary nature of some esophageal melanomas. This case also documents the occurrence of PMME in a patient positive for human immunodeficiency virus. We also provide a review of the relevant literature.
(Arch Pathol Lab Med. 2008;132:1675-1678)
Primary malignant melanoma of the esophagus (PMME) is an extremely rare neoplasm representing 0.1% to 0.2% of all primary esophageal cancers.1 To date, there are fewer than 300 cases reported in the world's literature. Despite the growing number of reported cases, the exact histogenesis of this primary malignancy remains elusive. It is believed that the presence of increased melanoblasts within the basal layers of the squamous mucosa may predispose to subsequent development of melanoma. To further elucidate the subject, we present a case of PMME with associated junctional activity and separate foci of atypical melanocytic hyperplasia, melanoma in situ, and early invasive malignant melanoma in a patient with a longstanding diagnosis of human immunodeficiency virus (HIV) infection. To our knowledge, only 1 other case has been reported in the literature that demonstrated the entire progression of disease from benign melanocytic hyperplasia to atypical melanocytic hyperplasia to melanoma in situ in association with an invasive melanoma.2 Additionally, our search of the literature revealed no other reported cases of PMME in an HIV-positive patient. In addition to adding data to the limited reports of PMME, this case provides additional evidence about the primary nature of the disease and its evolution from melanocytic hyperplasia of the esophagus. This case also documents...