Patterns of care and survival outcomes in the treatment of esophageal melanoma.

Because of the rarity of esophageal melanoma, the optimal management of this disease is limited. The pooled dataset in the National Cancer Database (NCDB) was used to identify the prognostic factors and treatment outcomes. Patients who were diagnosed with esophageal melanoma between 2004 and 2011 were identified. Patients were stratified as either localized (T1-4N0M0), regional (T1-4N+M0), or metastatic (M1). The primary endpoint of this study was overall survival (OS) which was analyzed using the Kaplan-Meier method and multivariate Cox regression, which was performed to identify potential factors influencing survival. A total of 56 patients were identified with median follow-up of 10.2 months. Twenty-seven (48.2%) patients had localized disease, 10 patients (17.9%) had regional disease, and 19 patients (33.9%) were metastatic at diagnosis. For those with localized disease, the 3 year OS was 50.5% for the 14 patients treated with esophagectomy, and 0.0% for the seven treated with definitive radiation therapy. For regional disease, the 3 year OS was 11.1% for the nine patients treated with esophagectomy. The 3 year OS for those with metastatic disease at diagnosis was 0.0%. On multivariate analysis, treatment with esophagectomy was not associated with a reduced risk of death (HR 0.84, 95% CI 0.31-2.25, P = 0.73), while regional disease (HR 3.78, 95% CI 1.40-10.19, P = 0.009) and metastatic disease (HR 7.54, 95% CI 2.89-19.62, P < 0.001) were associated with decreased survival. Esophageal melanoma is an extremely rare and aggressive disease with very poor outcomes. Esophagectomy may result in reasonable survival for localized disease.