www.cureus.com
Open in
urlscan Pro
104.22.4.111
Public Scan
Submitted URL: https://www.cureus.com/articles/73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female#!/
Effective URL: https://www.cureus.com/articles/73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female
Submission: On September 30 via manual from AU — Scanned from AU
Effective URL: https://www.cureus.com/articles/73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female
Submission: On September 30 via manual from AU — Scanned from AU
Form analysis 5 forms found in the DOM
<form accept-charset="UTF-8">
<div class="not-logged-in">Please <a>sign in</a> or <a>sign up</a> to comment.</div>
</form>POST /publish/articles/73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female/send_sign_up_email?source=PDFDownload
<form id="pdf-email-form" action="/publish/articles/73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female/send_sign_up_email?source=PDFDownload" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden"
value="✓"><input type="hidden" name="authenticity_token" value="ygmVlFSxEROIqlDnHYzp06iVsj+OLvaiV5Y9QgSq5DqSWJXuBwVpmUPXi4OKIEHUJ1I5mJ/iE05g6BV1d4JbOQ==">
<div class="large-8 large-offset-1 medium-8 medium-offset-1 columns">
<input type="email" name="email" id="email" required="required">
</div>
<div class="large-1 medium-1 columns end">
<input type="submit" name="commit" value="send" class="button special" id="pdf-download-button" data-disable-with="send">
</div>
</form>POST /users/sign_in?id=73132&return_to=%2Farticles%2F73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female
<form class="new_user" id="new_user" action="/users/sign_in?id=73132&return_to=%2Farticles%2F73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden"
value="✓"><input type="hidden" name="authenticity_token" value="ygmVlFSxEROIqlDnHYzp06iVsj+OLvaiV5Y9QgSq5DqSWJXuBwVpmUPXi4OKIEHUJ1I5mJ/iE05g6BV1d4JbOQ==">
<div class="form-label-input-wrap no-label no-padding">
<div class="text-wrap">
<label>Sign in with your email address:</label>
</div>
</div>
<div class="form-label-input-wrap">
<label class="email-label" for="user_email">Email</label>
<div class="input-wrap">
<input required="required" autofocus="autofocus" type="email" name="user[email]" id="user_email">
</div>
</div>
<div class="form-label-input-wrap">
<label for="user_password">Password</label>
<div class="input-wrap">
<input required="required" type="password" name="user[password]" id="user_password">
</div>
</div>
<input value="true" type="hidden" name="user[remember_me]" id="user_remember_me">
<div class="form-label-input-wrap no-label no-padding">
<div class="devise-submit-wrap">
<input type="submit" name="commit" value="Sign in" class="button primary large input-wrap" data-disable-with="Sign in">
</div>
</div>
</form>POST /registrations?article_id=73132&return_to=%2Farticles%2F73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female&user_type=comment
<form class="new_user" id="continue_registration" data-parsley-validate="true" action="/registrations?article_id=73132&return_to=%2Farticles%2F73132-primary-malignant-melanoma-of-the-esophagus-in-a-76-year-old-female&user_type=comment"
accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input type="hidden" name="authenticity_token" value="ygmVlFSxEROIqlDnHYzp06iVsj+OLvaiV5Y9QgSq5DqSWJXuBwVpmUPXi4OKIEHUJ1I5mJ/iE05g6BV1d4JbOQ==">
<div class="form-label-input-wrap">
<label for="user_first_name">First name</label>
<div class="input-wrap">
<input autofocus="autofocus" required="required" tabindex="1" type="text" name="user[first_name]" id="user_first_name">
</div>
</div>
<div class="form-label-input-wrap">
<label for="user_last_name">Last name</label>
<div class="input-wrap">
<input autofocus="autofocus" required="required" tabindex="2" type="text" name="user[last_name]" id="user_last_name">
</div>
</div>
<div class="form-label-input-wrap">
<label for="user_email">Email</label>
<div class="input-wrap">
<input required="required" autofocus="autofocus" tabindex="3" type="email" name="user[email]" id="user_email">
</div>
</div>
<div class="form-label-input-wrap">
<label for="user_password">Password</label>
<div class="input-wrap">
<input required="required" tabindex="4" type="password" name="user[password]" id="user_password">
</div>
</div>
<div class="form-label-input-wrap">
<label class="text control-label" for="user_specialty_id">Specialty</label>
<div class="input-wrap">
<select required="required" name="user[specialty_id]" id="user_specialty_id">
<option value="">Please choose</option>
<option selected="selected" value="361">I'm not a medical professional.</option>
<option value="2">Allergy and Immunology</option>
<option value="357">Anatomy</option>
<option value="3">Anesthesiology</option>
<option value="237">Cardiac/Thoracic/Vascular Surgery</option>
<option value="249">Cardiology</option>
<option value="283">Critical Care</option>
<option value="360">Dentistry</option>
<option value="10">Dermatology</option>
<option value="284">Diabetes and Endocrinology</option>
<option value="13">Emergency Medicine</option>
<option value="246">Epidemiology and Public Health</option>
<option value="21">Family Medicine</option>
<option value="363">Forensic Medicine</option>
<option value="285">Gastroenterology</option>
<option value="371">General Practice</option>
<option value="47">Genetics</option>
<option value="352">Geriatrics</option>
<option value="368">Health Policy</option>
<option value="369">Hematology</option>
<option value="281">HIV/AIDS</option>
<option value="282">Hospital-based Medicine</option>
<option selected="selected" value="361">I'm not a medical professional.</option>
<option value="286">Infectious Disease</option>
<option value="353">Integrative/Complementary Medicine</option>
<option value="27">Internal Medicine</option>
<option value="362">Internal Medicine-Pediatrics</option>
<option value="314">Medical Education and Simulation</option>
<option value="219">Medical Physics</option>
<option value="370">Medical Student</option>
<option value="287">Nephrology</option>
<option value="59">Neurological Surgery</option>
<option value="177">Neurology</option>
<option value="60">Nuclear Medicine</option>
<option value="364">Nutrition</option>
<option value="61">Obstetrics and Gynecology</option>
<option value="367">Occupational Health</option>
<option value="267">Oncology</option>
<option value="69">Ophthalmology</option>
<option value="372">Optometry</option>
<option value="359">Oral Medicine</option>
<option value="70">Orthopaedics</option>
<option value="358">Osteopathic Medicine</option>
<option value="73">Otolaryngology</option>
<option value="354">Pain Management</option>
<option value="355">Palliative Care</option>
<option value="78">Pathology</option>
<option value="114">Pediatrics</option>
<option value="291">Pediatric Surgery</option>
<option value="135">Physical Medicine and Rehabilitation</option>
<option value="143">Plastic Surgery</option>
<option value="351">Podiatry</option>
<option value="146">Preventive Medicine</option>
<option value="162">Psychiatry</option>
<option value="244">Psychology</option>
<option value="288">Pulmonology</option>
<option value="213">Radiation Oncology</option>
<option value="207">Radiology</option>
<option value="289">Rheumatology</option>
<option value="366">Substance Use and Addiction</option>
<option value="225">Surgery</option>
<option value="365">Therapeutics</option>
<option value="356">Trauma</option>
<option value="239">Urology</option>
<option value="150">Miscellaneous</option>
</select>
</div>
</div>
<div class="row">
<div class="large-12 columns">
<h4 class="reg">Email Communication and Personal Data</h4>
</div>
</div>
<div class="row">
<div class="large-1 medium-1 small-1 columns">
<input name="user[email_preference][gdpr_verify]" type="hidden" value="0"><input required="required" name="user[email_preference][gdpr_verify]" type="checkbox" value="1" id="user_gdpr_verify">
</div>
<div class="large-11 medium-11 small-11 columns">
<label for="user_gdpr_verify">Cureus personal data will never be sold to third parties and will only be used to enrich the user experience and contact you in direct relation to the application. I agree to opt in to this communication.</label>
</div>
</div>
<div class="form-label-input-wrap recaptcha-centered modal">
<script src="https://www.recaptcha.net/recaptcha/api.js" async="" defer=""></script>
<div data-sitekey="6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG" class="g-recaptcha ">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-jqcnsqrs6p1u" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"
src="https://www.recaptcha.net/recaptcha/api2/anchor?ar=1&k=6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG&co=aHR0cHM6Ly93d3cuY3VyZXVzLmNvbTo0NDM.&hl=en&v=pxZcVU8Dk73FyvFvdCgp2MSG&size=normal&cb=v1f54a8xao13"></iframe>
</div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div>
</div>
<noscript>
<div>
<div style="width: 302px; height: 422px; position: relative;">
<div style="width: 302px; height: 422px; position: absolute;">
<iframe src="https://www.recaptcha.net/recaptcha/api/fallback?k=6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG" name="ReCAPTCHA" style="width: 302px; height: 422px; border-style: none; border: 0; overflow: hidden;">
</iframe>
</div>
</div>
<div style="width: 300px; height: 60px; border-style: none;
bottom: 12px; left: 25px; margin: 0px; padding: 0px; right: 25px;
background: #f9f9f9; border: 1px solid #c1c1c1; border-radius: 3px;">
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid #c1c1c1;
margin: 10px 25px; padding: 0px; resize: none;"> </textarea>
</div>
</div>
</noscript>
</div>
<div class="form-label-input-wrap no-label-new modal">
<p class="text-wrap submit-text-wrap modal"> By joining Cureus, you agree to our <a href="/privacy">Privacy Policy</a> and <a href="/terms">Terms of Use</a>. </p>
</div>
<div class="form-label-input-wrap no-label modal">
<div class="devise-submit-wrap modal">
<input type="submit" name="commit" value="Sign up" class="button primary large input-wrap modal" data-disable-with="Sign up">
</div>
</div>
</form>POST /ads_sponsorship/submit_ad_inquiry
<form class="new_advertising_inquiry" id="new_advertising_inquiry" action="/ads_sponsorship/submit_ad_inquiry" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input type="hidden" name="authenticity_token"
value="ygmVlFSxEROIqlDnHYzp06iVsj+OLvaiV5Y9QgSq5DqSWJXuBwVpmUPXi4OKIEHUJ1I5mJ/iE05g6BV1d4JbOQ=="><input type="hidden" name="advertising_inquiry[user_id]" id="advertising_inquiry_user_id">
<div class="form-label-input-wrap">
<div class="input-wrap">
<input placeholder="First name" type="text" name="advertising_inquiry[first_name]" id="advertising_inquiry_first_name">
</div>
</div>
<div class="form-label-input-wrap">
<div class="input-wrap">
<input placeholder="Last name" type="text" name="advertising_inquiry[last_name]" id="advertising_inquiry_last_name">
</div>
</div>
<div class="form-label-input-wrap">
<div class="input-wrap">
<input type="email" placeholder="Email address" name="advertising_inquiry[email]" id="advertising_inquiry_email">
</div>
</div>
<div class="form-label-input-wrap">
<div class="input-wrap">
<input placeholder="Name of organization" type="text" name="advertising_inquiry[organization_name]" id="advertising_inquiry_organization_name">
</div>
</div>
<div class="form-label-input-wrap">
<div class="input-wrap">
<input placeholder="Message (optional)" type="text" name="advertising_inquiry[message]" id="advertising_inquiry_message">
</div>
</div>
<div class="receive-updates">
<input name="advertising_inquiry[receive_updates]" type="hidden" value="0"><input type="checkbox" value="1" checked="checked" name="advertising_inquiry[receive_updates]" id="advertising_inquiry_receive_updates">
<label class="checkbox_description" for="advertising_inquiry_receive_updates">I would like to receive Cureus newsletters and updates.</label>
</div>
<div class="form-label-input-wrap">
<script src="https://www.recaptcha.net/recaptcha/api.js" async="" defer=""></script>
<div data-sitekey="6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG" class="g-recaptcha ">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-xe9vxychepke" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"
src="https://www.recaptcha.net/recaptcha/api2/anchor?ar=1&k=6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG&co=aHR0cHM6Ly93d3cuY3VyZXVzLmNvbTo0NDM.&hl=en&v=pxZcVU8Dk73FyvFvdCgp2MSG&size=normal&cb=8gjg6e7xc3dj"></iframe>
</div><textarea id="g-recaptcha-response-1" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
<noscript>
<div>
<div style="width: 302px; height: 422px; position: relative;">
<div style="width: 302px; height: 422px; position: absolute;">
<iframe src="https://www.recaptcha.net/recaptcha/api/fallback?k=6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG" name="ReCAPTCHA" style="width: 302px; height: 422px; border-style: none; border: 0; overflow: hidden;">
</iframe>
</div>
</div>
<div style="width: 300px; height: 60px; border-style: none;
bottom: 12px; left: 25px; margin: 0px; padding: 0px; right: 25px;
background: #f9f9f9; border: 1px solid #c1c1c1; border-radius: 3px;">
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid #c1c1c1;
margin: 10px 25px; padding: 0px; resize: none;"> </textarea>
</div>
</div>
</noscript>
<br>
</div>
<input type="submit" name="commit" value="Download" class="button success expand large media-kit-submit-button" data-disable-with="Download">
</form>Text Content
* Home
* Specialties
Specialties
BROWSE
Articles Posters Abstracts Cureus Collections
SPECIALTIES
* Allergy / Immunology
* Anatomy
* Anesthesiology
* Cardiac / Thoracic / Vascular Surgery
* Cardiology
* Dentistry
* Dermatology
* Emergency Medicine
* Endocrinology / Diabetes / Metabolism
* Environmental Health
* Epidemiology / Public Health
* Family / General Practice
* Forensic Medicine
* Gastroenterology
* General Surgery
* Genetics
* Geriatrics
* Healthcare Technology
* Health Policy
* Hematology
* HIV / AIDS
* Infectious Disease
* Integrative / Complementary Medicine
* Internal Medicine
* Medical Education
* Medical Physics
* Medical Simulation
* Nephrology
* Neurology
* Neurosurgery
* Nuclear Medicine
* Nutrition
* Obstetrics / Gynecology
* Occupational Health
* Oncology
* Ophthalmology
* Oral Medicine
* Orthopedics
* Osteopathic Medicine
* Otolaryngology
* Pain Management
* Palliative Care
* Pathology
* Pediatrics
* Pediatric Surgery
* Physical Medicine & Rehabilitation
* Plastic Surgery
* Podiatry
* Preventive Medicine
* Psychiatry
* Psychology
* Public Health
* Pulmonology
* Quality Improvement
* Radiation Oncology
* Radiology
* Rheumatology
* Sports Medicine
* Substance Use and Addiction
* Therapeutics
* Transplantation
* Trauma
* Urology
* Miscellaneous
* Resources
Resources
ABOUT PUBLISHING
Why publish in Cureus? Click below to find out.
Learn more
FOR AUTHORS & REVIEWERS
* Author Guide
* Reviewer Guide
* Media Guide
* Author Fees (Preferred Editing)
* Cureus Honors
* Article Promotion
* Article Sharing Guide
* SIQ
* Academic Channels
Academic Channels
ABOUT CHANNELS
Unlock discounted publishing that highlights your organization and the
peer-reviewed research and clinical experiences it produces.
Learn more
CHANNELS
* AARA by IMG Helping Hands™
* ACOS Cardiothoracic and Vascular Surgery
* ACOS General Surgery
* ACOS Neurological Surgery
* ACOS Plastic and Reconstructive Surgery
* ACOS Urological Surgery
* Advanced Sciences Academic Channel
* Alabama College of Osteopathic Medicine Research
* American Red Cross Scientific Advisory Council
* Annals of Health Innovation
* Annals of Simulation
* Aurora Breast Health Proceedings
* Autism and Health: Across the Lifespan
* Baylor Scott & White Medical Center Department of Neurosurgery
* BioLEAGUES
* California Institute of Behavioral Neurosciences & Psychology
* Canadian Association of Radiation Oncology
* Contemporary Reviews in Neurology and Neurosurgery
* Dalhousie Emergency Medicine
* Datta Meghe Medical College
* DMIHER Center for Advanced Physiotherapy Education & Research
* DMIMS School of Epidemiology and Public Health
* Dr. Kiran C. Patel College of Allopathic Medicine (NSUMD)
* Dr. Kiran C. Patel College of Osteopathic Medicine (KPCOM)
* FLAGSHIP: Medical Scholarly Proceedings
* Florida Atlantic University
* Florida International University
* Florida State University
* Global Remote Research Scholars Program
* Howard University Internal Medicine
* International Liaison Committee on Resuscitation
* International Pediatric Simulation Society
* Japan Radiosurgery Society
* Jawaharlal Nehru Medical College
* Lake Erie College of Osteopathic Medicine (LECOM)
* Liberty Medicine Research Channel
* Medical Society of Delaware Academic Channel
* Med-Peds Academic Channel
* Military Medical Simulation
* Modern Medical Educator
* NB Social Pediatrics Research
* NEMA Research Group
* NYC Health + Hospitals/Woodhull
* Paolo Procacci Foundation
* Penn State Neurosurgery
* Research Update Organization
* Saveetha Institute of Medical and Technical Sciences
* SBH Health System
* Simulation, Biodesign, & Innovation In Medical Education
* Sinai Chicago Research
* Society for Healthcare & Research Development
* Stanford Neurosurgery
* Texas Tech University Health Sciences Center El Paso
* The Florida Medical Student Research Publications
* the Radiosurgery Society
* UCSF Surgical Neuroanatomy Collection
* University of Florida College of Medicine – Jacksonville
* University of Florida-Jacksonville Neurosurgery
* University of Louisville Neurosurgery
* University of Munich Neurology
* University of South Florida
* VCOM Clinical, Biomedical, and Educational Research
* William Carey University College of Osteopathic Medicine Scholarly
Activities
* Partnerships
Partnerships
MEDIA KIT
Offering a variety of advertising and sponsorship options for reaching
influential specialists from targeted demographic splits.
Download Media Kit
ADVERTISING & SPONSORSHIP
* Advertise With Us
* Advertising Policy
* Cureus Partnerships
COMPETITIONS
* About Competitions
* Competition Archive
* Newsroom
Newsroom
BROWSE
All News Cureus U Newsletters
HIGHLIGHTS
* Call for Submissions Complete: AI and Robotics in Healthcare
* Latest Highlighted Internal Medicine Articles
* Latest Highlighted Anesthesiology Articles
* Latest Highlighted Gastroenterology Articles
* Latest Highlighted Pediatric Articles
* Latest Highlighted Radiology Articles
* About Us
About Us
ABOUT CUREUS
Cureus provides an equitable, efficient publishing and peer reviewing
experience without sacrificing publication times.
Learn more
WHO WE ARE
* Editorial Board
* Associate Editors
* Academic Council
CONTRIBUTORS
* Authors
* Reviewers
MORE FROM CUREUS
* Careers
* Email Alerts
* ISSN #2168-8184
*
*
* Sign In
* Create an Account
* Specialties
BROWSE
Articles
Posters
Abstracts
Cureus Collections
SPECIALTIES
More
Allergy / Immunology
Anatomy
Anesthesiology
Cardiac / Thoracic / Vascular Surgery
Cardiology
Dentistry
Dermatology
Emergency Medicine
Endocrinology / Diabetes / Metabolism
Environmental Health
Epidemiology / Public Health
Family / General Practice
Forensic Medicine
Gastroenterology
General Surgery
Genetics
Geriatrics
Healthcare Technology
Health Policy
Hematology
HIV / AIDS
Infectious Disease
Integrative / Complementary Medicine
Internal Medicine
Medical Education
Medical Physics
Medical Simulation
Nephrology
Neurology
Neurosurgery
Nuclear Medicine
Nutrition
Obstetrics / Gynecology
Occupational Health
Oncology
Ophthalmology
Oral Medicine
Orthopedics
Osteopathic Medicine
Otolaryngology
Pain Management
Palliative Care
Pathology
Pediatrics
Pediatric Surgery
Physical Medicine & Rehabilitation
Plastic Surgery
Podiatry
Preventive Medicine
Psychiatry
Psychology
Public Health
Pulmonology
Quality Improvement
Radiation Oncology
Radiology
Rheumatology
Sports Medicine
Substance Use and Addiction
Therapeutics
Transplantation
Trauma
Urology
Miscellaneous
* Resources
ABOUT PUBLISHING
Why publish in Cureus? Click below to find out.
LEARN MORE
FOR AUTHORS & REVIEWERS
Author Guide
Author Fees (Preferred Editing)
Article Sharing Guide
Reviewer Guide
Cureus Honors
SIQ
Media Guide
Article Promotion
* Academic Channels
ABOUT CHANNELS
Unlock discounted publishing that highlights your organization and the
peer-reviewed research and clinical experiences it produces.
LEARN MORE
CHANNELS
More
AARA by IMG Helping Hands™
ACOS Cardiothoracic and Vascular Surgery
ACOS General Surgery
ACOS Neurological Surgery
ACOS Plastic and Reconstructive Surgery
ACOS Urological Surgery
Advanced Sciences Academic Channel
Alabama College of Osteopathic Medicine Research
American Red Cross Scientific Advisory Council
Annals of Health Innovation
Annals of Simulation
Aurora Breast Health Proceedings
Autism and Health: Across the Lifespan
Baylor Scott & White Medical Center Department of Neurosurgery
BioLEAGUES
California Institute of Behavioral Neurosciences & Psychology
Canadian Association of Radiation Oncology
Contemporary Reviews in Neurology and Neurosurgery
Dalhousie Emergency Medicine
Datta Meghe Medical College
DMIHER Center for Advanced Physiotherapy Education & Research
DMIMS School of Epidemiology and Public Health
Dr. Kiran C. Patel College of Allopathic Medicine (NSUMD)
Dr. Kiran C. Patel College of Osteopathic Medicine (KPCOM)
FLAGSHIP: Medical Scholarly Proceedings
Florida Atlantic University
Florida International University
Florida State University
Global Remote Research Scholars Program
Howard University Internal Medicine
International Liaison Committee on Resuscitation
International Pediatric Simulation Society
Japan Radiosurgery Society
Jawaharlal Nehru Medical College
Lake Erie College of Osteopathic Medicine (LECOM)
Liberty Medicine Research Channel
Medical Society of Delaware Academic Channel
Med-Peds Academic Channel
Military Medical Simulation
Modern Medical Educator
NB Social Pediatrics Research
NEMA Research Group
NYC Health + Hospitals/Woodhull
Paolo Procacci Foundation
Penn State Neurosurgery
Research Update Organization
Saveetha Institute of Medical and Technical Sciences
SBH Health System
Simulation, Biodesign, & Innovation In Medical Education
Sinai Chicago Research
Society for Healthcare & Research Development
Stanford Neurosurgery
Texas Tech University Health Sciences Center El Paso
The Florida Medical Student Research Publications
the Radiosurgery Society
UCSF Surgical Neuroanatomy Collection
University of Florida College of Medicine – Jacksonville
University of Florida-Jacksonville Neurosurgery
University of Louisville Neurosurgery
University of Munich Neurology
University of South Florida
VCOM Clinical, Biomedical, and Educational Research
William Carey University College of Osteopathic Medicine Scholarly Activities
* Partnerships
MEDIA KIT
Offering a variety of advertising and sponsorship options for reaching
influential specialists from targeted demographic splits.
DOWNLOAD MEDIA KIT
ADVERTISING & SPONSORSHIPS
COMPETITIONS
Advertise With Us
About Competitions
Advertising Policy
Competition Archive
Cureus Partnerships
* Newsroom
BROWSE
All
News
Cureus U
Newsletters
HIGHLIGHTS
More
Call for Submissions Complete: AI and Robotics in Healthcare
Latest Highlighted Internal Medicine Articles
Latest Highlighted Anesthesiology Articles
Latest Highlighted Gastroenterology Articles
Latest Highlighted Pediatric Articles
Latest Highlighted Radiology Articles
* About Us
ABOUT CUREUS
Cureus provides an equitable, efficient publishing and peer reviewing
experience without sacrificing publication times.
LEARN MORE
WHO WE ARE
CONTRIBUTORS
MORE FROM CUREUS
Editorial Board
Authors
Careers
Associate Editors
Reviewers
Email Alerts
Academic Council
SUBMIT RESEARCH SIGN IN JOIN NOW
6.6
RATED BY 2 READERS
6.9
CLARITY OF BACKGROUND AND RATIONALE
6.7
CLINICAL IMPORTANCE
5.9
STUDY DESIGN AND METHODS
6.9
DATA ANALYSIS
6.3
NOVELTY OF CONCLUSIONS
6.9
QUALITY OF PRESENTATION
CONTRIBUTE RATING
Learn more about SIQ™
6.6
Rate Article
What's This?
--------------------------------------------------------------------------------
TABLE OF CONTENTS
--------------------------------------------------------------------------------
CATEGORIES
* Internal Medicine
* Gastroenterology
* Oncology
--------------------------------------------------------------------------------
KEYWORDS
ADVERTISEMENT
Case Report
•
Peer-Reviewed
•
More info
PRIMARY MALIGNANT MELANOMA OF THE ESOPHAGUS IN A 76-YEAR-OLD FEMALE
Simon Kashfi • Naimisha Marneni • Shorabh Sharma • Ivette Vigoda
Simon Kashfi • Naimisha Marneni • Shorabh Sharma • Ivette Vigoda
Published: March 17, 2022
DOI: 10.7759/cureus.23250
Peer-Reviewed
Cite this article as: Kashfi S, Marneni N, Sharma S, et al. (March 17, 2022)
Primary Malignant Melanoma of the Esophagus in a 76-Year-Old Female. Cureus
14(3): e23250. doi:10.7759/cureus.23250
ADVERTISEMENT
Article
Authors etc.
Metrics
Media
Comments
ABSTRACT
Mucosal melanomas represent about 1% of all melanoma cases. Primary malignant
melanoma of the esophagus (PMME) is a rare and deadly condition, with only about
339 cases reported in the literature. Esophageal melanoma usually presents with
progressively worsening dysphagia, and patients often present late in the
disease course. Esophageal melanoma can be treated with surgical resection,
chemotherapy, targeted therapy, or immunotherapy depending on the stage and
tumor mutations. However, due to the rarity of the disease, no trials have been
performed to deliver a gold standard of treatment. We present the case of a
76-year-old female who was diagnosed with metastatic primary malignant melanoma
of the esophagus and underwent treatment with nivolumab, a PD-1 receptor
antagonist.
INTRODUCTION
Melanomas are malignant tumors arising from pigment cells called melanocytes
that most often occur on the skin [1]. The incidence of malignant melanoma was
20.1/100,000 in 2007 [2]. It occurs mostly in light-skinned populations due to
differences in skin pigmentation. The most common locations for cutaneous
malignant melanoma are sex-dependent. Men tend to have lesions on their backs,
while women on their arms and legs [2]. The most important risk factor for
malignant melanoma is exposure to UV-B radiation [2,3]. Other risk factors
include increased number and size of melanocytic nevi, sunburns suffered early
in life, and classic phenotypic characteristics such as freckles and fair hair,
skin, and eyes [2,3]. Additionally, melanomas can rarely occur at mucosal
surfaces, representing 1% of melanoma cases [4]. Mucosal melanomas can occur
because melanocytes are derived from neural crest cells and migrate to various
sites [1]. Mucosal melanomas have been reported to occur in the gastrointestinal
tract, respiratory tract, male and female genitourinary tracts, and mouth. Head
and neck mucosal melanomas are the most common. The literature surrounding
mucosal melanomas is primarily composed of case reports and case series due to
the rarity of the condition [1]. Primary malignant melanoma of the esophagus
(PMME) accounts for 0.1%-0.2% of primary esophageal neoplasms and is associated
with poor prognosis [5]. By 2016, there had only been 339 cases reported in the
literature [6]. We present the case of a 76-year-old female who was diagnosed
with PMME after presenting to the emergency department with several months of
dysphagia.
CASE PRESENTATION
The patient is a 76-year-old female nonsmoker with no reported medical history
who presented to our hospital with six months of chronic, worsening,
nonradiating epigastric pain that was 10/10 in severity that was not associated
with food intake. The symptoms initially began as difficulty with swallowing
liquids and early satiety. They progressed to difficulty with solids and
eventually to sialorrhea, as she was unable to swallow and had to spit liquids
out. During this period, she experienced nearly 40-pound weight loss with
associated anorexia and fatigue. On our initial clinical interaction, she was
noted to be cachectic, expectorating constantly, but in no acute distress. There
was no palpable lymphadenopathy.
Her initial laboratory results were remarkable for normocytic anemia secondary
to anemia of chronic disease with components of iron deficiency and
marked hypoalbuminemia. Hemoglobin was 10.3 g/dL, and albumin was 2.6 g/dL. CT
scan of the abdomen was significant for an intraluminal esophageal mass
measuring 4.9 × 4.2 cm axially and 12 cm in the craniocaudal dimension,
originating in the subcarinal region and extending to the gastroesophageal
junction. The mass compressed but did not occlude the right atrium and lower
pulmonary veins. The patient underwent an esophagogastroduodenoscopy (EGD) for
further evaluation, which showed a pigmented and lobulated esophageal mass
starting at 21 cm from the incisors, with the endoscope unable to pass beyond 40
cm from incisors with the esophageal mass still being visualized (Figure 1). The
biopsy samples taken were consistent with malignant melanoma supported by
positive staining with SOX10, HMB-45, Melan A, and vimentin immunohistochemical
markers, along with Fontana Masson special stain. Tumor cells were negative for
p63, p40, CK7, and CK20 immunostains and negative for iron and mucin special
stains. BRAF V600 mutation was not detected. Additionally, KIT activating
mutation, NRAS mutation, and NTRK fusion mutation were not detected. PET scan
revealed a metastatic melanoma predominantly involving the esophagus,
mediastinal lymph nodes, and bony disease consistent with stage IV
disease (Figure 2). There was no evidence of brain metastasis.
FIGURE 1: A AND B: VISUALIZATION OF THE PIGMENTED ESOPHAGEAL MASS DURING EGD
FIGURE 2: PET SCAN WITH SIGNIFICANT INVOLVEMENT OF THE ESOPHAGUS
After evaluation by a multidisciplinary team, a combined decision was made by
the family to initiate palliative chemoradiation. Subsequently, the patient
underwent placement of a gastrostomy tube to maximize the quality of life given
dysphagia with severe malnutrition and anticipated radiation, which could likely
worsen the dysphagia. After discussion at an interdisciplinary melanoma tumor
board, the patient was started on single-agent nivolumab given an Eastern
Cooperative Oncology Group performance status score of 4. She received two doses
of nivolumab 480 mg, four weeks apart, with no improvement of symptoms, and
continued decondition, suggesting progressive disease not responding to
treatment. The patient never received radiation because she missed her
appointment with the radiation oncologist. Thereafter, an informed decision was
made by the family to transition to hospice care. Death occurred two months
after the last dose of nivolumab. The time from initial presentation to
initiation of treatment was about one month, and the death occurred about 4.5
months after diagnosis.
DISCUSSION
The most common presenting symptom in PMME, as noted in the existing literature
and shown in several case reports, is dysphagia [1,5-9]. This patient presented
with several months of dysphagia, similar to the series of patients described by
Wang et al. [6]. Patients often present only when their dysphagia has gotten too
severe for them to manage, and unfortunately, this is often too late. It was at
this point in our case that the patient presented. She received a CT scan and
subsequent EGD, which was to visualize the mass found on CT and take a biopsy
sample.
EGD can reveal a pigmented mass, such as our patient had [8]. An ulcerated mass
is a predictor of poor prognosis [7]. However, there are cases where the mass is
not pigmented and is still found to be melanoma [5,9-11]. In these cases, the
diagnosis of primary malignant amelanotic melanoma of the esophagus is made when
there are no melanocytes on microscopic examination [11]. Our patient’s mass was
located starting 21 cm from the incisors and was still able to be visualized at
40 cm from the incisors, at which point the tube was no longer passed. This
location is classic for PMME, which occurs most often at the distal third of the
esophagus [1,5,7,8,11].
Histologically, the diagnosis of melanoma was supported by positive staining
with SOX10, HMB-45, Melan A, and vimentin immunostains and positive staining
with Fontana Masson special stain. HMB-45 is an indicator of active melanosome
formation [11] and, with Melan A, provides good specificity [8]. Classically,
cutaneous melanomas are positive for mutations in BRAF and NRAS [3].
Specifically, the BRAF V600E mutation is responsible for up to 90% of BRAF
mutations [12]. However, the rate of BRAF mutations is much less common in
mucosal melanomas; white KIT mutations are more common [3]. BRAF mutations occur
in 5%-20% of PMME. BRAF is an oncogene in the MAP kinase pathway, which is the
downstream signaling pathway for various growth factors. In a study of 76
patients with PMME, nine were positive for C-KIT mutation, five for BRAF, and
five for NRAS [6]. Our patient’s sample was negative for the BRAF V600E
mutation, KIT activating mutation, NRAS mutation, and NTRK fusion. This is
important because it did not offer any targetable mutations [13].
The staging of cancer helps guide its treatment. PMME is treated with surgical
resection if the disease is at a limited stage [6,8,10], and some patients have
had good outcomes [5]. However, even in those who had an excision considered to
be complete, 89.7% had recurrences, with a median recurrence time of 4.5 months
[6]. For metastatic disease, there is no preferred pharmacological regimen. Wang
et al. reviewed 60 patients with PMME who were treated with either chemotherapy,
targeted therapy, or immunotherapy. The chemotherapy group received either
dacarbazine, temozolomide, or paclitaxel + carboplatin. The targeted therapy
group received imatinib. The immunotherapy group received PD-1 checkpoint
inhibitors. Of the patients in the immunotherapy group, 75% had a partial
response to treatment, with a median response duration of 11.4 months [6]. Our
patient received nivolumab, a PD-1 receptor antagonist. Unfortunately, her
disease progressed, and treatment was stopped after two months, with death soon
after.
CONCLUSIONS
Primary malignant melanoma of the esophagus is a rare form of esophageal cancer.
Prognosis is poor and depends, among others, on the stage at diagnosis. There is
a high risk of recurrence even in those who had a primary surgical
resection. Those with metastatic disease and good performance status are
candidates for immunotherapy with PD-1 checkpoint inhibitors, although the
efficacy of these drugs is variable. Further research is warranted to determine
optimal treatment protocols.
REFERENCES
1. Yde SS, Sjoegren P, Heje M, Stolle LB: Mucosal melanoma: a literature
review. Curr Oncol Rep. 2018, 20:28. 10.1007/s11912-018-0675-0
2. Rastrelli M, Tropea S, Rossi CR, Alaibac M: Melanoma: Epidemiology, risk
factors, pathogenesis, diagnosis and classification. In Vivo. 2014,
28:1005-11.
3. Lugović-Mihić L, Ćesić D, Vuković P, Novak Bilić G, Šitum M, Špoljar S:
Melanoma development: current knowledge on melanoma pathogenesis. Acta
Dermatovenerol Croat. 2019, 27:163-8.
4. Goldemberg DC, Thuler LC, de Melo AC: An update on mucosal melanoma: future
directions. Acta Dermatovenerol Croat. 2019, 27:11-5.
5. Navarro-Ballester A, De Lazaro-De Molina S, Gaona-Morales J: Primary
malignant melanoma of the esophagus: a case report and review of the
literature. Am J Case Rep. 2015, 16:491-5. 10.12659/AJCR.894041
6. Wang X, Kong Y, Chi Z, et al.: Primary malignant melanoma of the esophagus:
a retrospective analysis of clinical features, management, and survival of
76 patients. Thorac Cancer. 2019, 10:950-6. 10.1111/1759-7714.13034
7. Lasota J, Kowalik A, Felisiak-Golabek A, et al.: Primary malignant melanoma
of esophagus: clinicopathologic characterization of 20 cases including
molecular genetic profiling of 15 tumors. Mod Pathol. 2019, 32:957-66.
10.1038/s41379-018-0163-y
8. Hu YM, Yan JD, Gao Y, Xia QA, Wu Y, Zhang ZY: Primary malignant melanoma of
esophagus: a case report and review of literature. Int J Clin Exp Pathol.
2014, 7:8176-80.
9. Ling C, Feng J, Li J, Liu Q: Primary malignant melanoma of the esophagus.
Turk J Gastroenterol. 2018, 29:711-3. 10.5152/tjg.2018.18065
10. Dey S, Rosero DS, Chotai A: Primary melanoma of esophagus mimicking a
carcinoma. Arch Iran Med. 2020, 23:56-8.
11. Koga N, Kubo N, Saeki H, et al.: Primary amelanotic malignant melanoma of
the esophagus: a case report. Surg Case Rep. 2019, 5:4.
10.1186/s40792-019-0564-2
12. Cheng L, Lopez-Beltran A, Massari F, MacLennan GT, Montironi R: Molecular
testing for BRAF mutations to inform melanoma treatment decisions: a move
toward precision medicine. Mod Pathol. 2018, 31:24-38.
10.1038/modpathol.2017.104
13. Tyrrell H, Payne M: Combatting mucosal melanoma: recent advances and future
perspectives. Melanoma Manag. 2018, 5:MMT11. 10.2217/mmt-2018-0003
6.6
RATED BY 2 READERS
6.9
CLARITY OF BACKGROUND AND RATIONALE
6.7
CLINICAL IMPORTANCE
5.9
STUDY DESIGN AND METHODS
6.9
DATA ANALYSIS
6.3
NOVELTY OF CONCLUSIONS
6.9
QUALITY OF PRESENTATION
CONTRIBUTE RATING
Learn more about SIQ™
6.6
RATED BY 2 READERS
Scholary Impact Quotient is our unique post-publication peer review rating
process
Read More
Contribute Article
What's This?
COMMENTS
0
* Sort By
* Oldest to Newest
* Newest to Oldest
--------------------------------------------------------------------------------
Please sign in or sign up to comment.
LOAD MORE
RELATED TOPICS
--------------------------------------------------------------------------------
primary malignant melanoma
dysphagia
nivolumab
melanoma
esophageal melanoma
ADVERTISEMENT
FURTHER READING
--------------------------------------------------------------------------------
Boerhaave’s Syndrome: An Unusual Geriatric Presentation
Serum Activities of Paraoxonase 1 (PON1) in Predicting Liver Damage Among
Patients Diagnosed With Hepatocellular Carcinoma: A Case-Control Study
A Retrospective Cohort Study of the Association of Inpatient Amlodipine Dose
With Renal Complication Rates and Hospital Length of Stay
Acute Recurrent Pancreatitis With Exclusion of Biliary Causes in a Young Female
Patient
Can Artificial Intelligence Beat Humans in Detecting Breast Malignancy on
Mammograms?
POPULAR RELATED ARTICLES
The Effect of Colchicine on Atrial Fibrillation: A Systematic Review and
Meta-Analysis
Sharath Kommu, Shalini Arepally
Left Ventricular Myxoma: A Case Report
Diya Asad, Mass A. Abu Moch +8 more
The Repairing of the Recto-Neovaginal Fistula in a Male-to-Female Transgender
Through Perineal Graciloplasty
Nail Omarov, Sedat Tatar
Inflammatory Arthritis Associated with COVID-19 Vaccination
Sai Man Mung, Tee Lin Goh +2 more
View More
ENTER YOUR EMAIL ADDRESS TO RECEIVE YOUR FREE PDF DOWNLOAD.
Please note that by doing so you agree to be added to our monthly email
newsletter distribution list.
New here? Sign up.
SIGN IN TO CUREUS
sign in using LinkedIn
sign in using Google
sign in using Facebook
--------------------------------------------------------------------------------
or
Sign in with your email address:
Email
Password
Don't have an account? Sign Up
Forgot your password?
Resend confirmation instructions
SIGN UP FOR CUREUS
sign up using LinkedIn
sign up using Google
sign up using Facebook
--------------------------------------------------------------------------------
or
First name
Last name
Email
Password
Specialty
Please choose I'm not a medical professional. Allergy and Immunology Anatomy
Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care
Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology
and Public Health Family Medicine Forensic Medicine Gastroenterology General
Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based
Medicine I'm not a medical professional. Infectious Disease
Integrative/Complementary Medicine Internal Medicine Internal
Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical
Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition
Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry
Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management
Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and
Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry
Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use
and Addiction Surgery Therapeutics Trauma Urology Miscellaneous
EMAIL COMMUNICATION AND PERSONAL DATA
Cureus personal data will never be sold to third parties and will only be used
to enrich the user experience and contact you in direct relation to the
application. I agree to opt in to this communication.
By joining Cureus, you agree to our Privacy Policy and Terms of Use.
DOWNLOAD CUREUS MEDIA KIT
I would like to receive Cureus newsletters and updates.
ClapView clapsDownload PDFDownload citationShare via emailSelect sharing
optionShare on RedditShare on FacebookShare on TwitterPublished: March 17, 2022
(see history)
DOI: 10.7759/cureus.23250Copy to clipboardDownload PDFDownload citationShare via
emailSelect sharing optionShare on RedditShare on FacebookShare on Twitter