A case report of primary gastroesophageal melanoma: Presentation, diagnosis, and surgical approach

Gastrointestinal tract is an uncommon site for primary melanoma and its annual incidence is reported 0.47 cases in million. Thus, limited information is available about its medical or surgical treatment, long-term complications of melanoma, and survival rates of each therapeutic method. A 47-year-old male was admitted to the emergency department with massive rectorrhagia. with not notable medical history except recent episodes of dyspepsia, melena, malaise and weight loss. Melena and weight loss in a 47-year-old patient is considered as suspicious signs for malignancy and should be investigated. The patient was finally diagnosed with primary gastrointestinal melanoma (PGIM). He underwent trans-hiatal total esophagectomy and proximal gastrectomy with gastric pull-up and lymph node dissection. Immunotherapy with Interferon-α was chosen as adjuvant therapy for this patient. After 10 months, CT scan of abdomen with intravenous and oral contrast revealed multiple foci in liver and spleen consistent with metastasis without any evidence of recurrence at primary tumor excision site. In this article, we presented a rare case of PGIM with later metastasis in liver and spleen. Gastric pull up was preferred to colon interposition for conduit reconstruction after esophagectomy in this case. However due to the rarity of this category of tumor more information must be gathered on the amount of margin to be resected and long-term outcome of different surgical approaches. Based on the poor prognosis of PGIM, less invasive surgical procedure which provides the radical resection and adequate onco-surgical dissection should be considered. •Primary gastrointestinal melanoma is very rare subtype of melanoma.•Management of primary gastrointestinal melanoma is challenging due to the poor prognosis of this malignant tumor.•Less invasive surgical procedure which provides the radical resection and adequate onco-surgical dissection should be considered.