Case Report: Locally advanced primary esophageal melanoma with early brain metastasis.

Introduction: Primary malignant melanoma of the esophagus (PMME) is a rare malignancy of the esophagus. The main treatment is esophagectomy, but the recurrence and metastasis rate are very high, and the prognosis is very poor. Here, we report a case of locally advanced PMME that rapidly developed intracranial metastases after surgery and adjuvant therapy. Case presentation: The patient was a 47-year-old male with dysphagia. Endoscopy revealed multiple cauliflower-like lesions in the middle esophagus, confirmed as malignant melanoma via biopsy with positive immunohistochemical staining for SOX-10 and Melan-A, with regional lymph node metastases. The patient was diagnosed with PMME and was treated with radical esophagectomy. The adjuvant therapy used tislelizumab combined with lenvatinib. Five months after surgery, follow-up magnetic resonance imaging (MRI) indicated multiple intracranial metastases. The patient underwent a tumor resection of the left cerebellar lesion, and stereotactic radiosurgery for other lesions, and received oral temozolomide. One month after radiotherapy, his condition deteriorated rapidly, showing systemic progression, and he eventually passed away ten months after diagnosis. Conclusion: Despite surgical resection and adjuvant therapy, this case of PMME rapidly progressed with multiple intracranial metastases, highlighting the highly aggressive nature and poor prognosis of this malignancy.