Curative Circumferential Endoscopic Submucosal Dissection of a Primary Pigmented Melanoma of the Esophagus After RFA of Barrett Esophagus

Aims Here we present the case of an 85-year-old male who had received multiple treatment for dysplasia in a Barrett´s esophagus by radiofrequency ablation (RFA) and APC. On endoscopic follow up 16 months after the last the patient showed multiple small polypoid (0-IIa) lesions of black color extending in the former Barrett area which histologically turned out to be a malignant melanoma.

Methods Staging (including EUS and PET CT) did not show lymph node or distant metastasis. The lesion was resected en bloc by circumferential endoscopic submucosal dissection (ESD).

Results Histopathology showed an R0 resected malignant melanoma with tumor thickness of 1,7 mm and a maximum tumor length axis of 5 cm. Safety margin of 0,1 cm (vertical) and 0,2 cm (lateral), no infiltration of the submucosal layer was revealed. The tumor was negative for BRAF- n-RAS- or cKIT mutation and no MSI. After interdisciplinary discussion of the case, adjuvant treatment with Nivolumab was recommended. The treatment was started 2 months after ESD. A close follow up was initiated.

Conclusions PMME are rare tumors arising in > 90 % of the cases in the distal part of the esophagus. In the case presented the tumor had developed after treatment of Barrett’s esophagus by RFA and APC. Thus, it can be speculated that either condition or both contributed to the PMME development. ESD was successful for curative minimal invasive and organ preserving treatment in this elderly comorbid patient.

Citation: Dumoulin J, Abdelhafez M, von Figura G et al. eP30 CURATIVE CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION OF A PRIMARY PIGMENTED MELANOMA OF THE ESOPHAGUS AFTER RFA OF BARRETT ESOPHAGUS. Endoscopy 2021; 53: S107.

Publication History

Article published online:
19 March 2021