Objective To investigate the clinical characteristics,treatment methods and prognosis of primary malignant melanoma of the esophagus(PMME). Methods 17 PMME patients who received surgical treatment in the Fourth Hospital of Hebei Medical University from March 1993 to January 2014 were analysed. Clinical symptoms, laboratory examination results and treatment methods were recorded,and prognosis was observed. Survival rate was calculated using Kaplan- Meier method,and analysis of prognosis was conducted using Cox regression model. Results After pathological staging,4 patients were found at stageⅠ,7 patients were at stage Ⅱ,and 6 patients were at stage Ⅲ;lymphatic metastasis occurred in 11 patients,and 6 patients had no lymphatic metastasis. The tumor was found in the middle and lower part of the esophagus in all the patients. The observation through esophagoscope showed gray black mass(8 / 17) or overlying filthy gray black moss like mass(5 / 17)in esophagus lumen. All the patients underwent esophageal carcinoma resection,esophagogastrostomy and lymph node dissection,with a resection rate of 100% . Postoperative adjuvant therapy was undertaken on 11 patients,and 6 patients didn't receive adjuvant therapy. The average survival time was 23. 5 months,with a median survival time of 16. 0 months,and 1- year,3 - year and 5 - year survival rates were 58. 8% ,17. 7% and 11. 8% respectively. The patients at different pathological stages were significantly different in survival curve( χ2 = 12. 150,P = 0. 002). The patients without lymphatic metastasis and with lymphatic metastasis were significantly different in surivial curve(χ2 = 8. 855,P = 0. 003). The patients who received adjuvant therapy and patients who didn't receive adjuvant therapy were not significantly different in survival curve (χ2 = 0. 049,P = 0. 824). Multivariate Cox regression analysis showed that pathological staging was an independent influencing factor for survival and prognosis of PMME patients〔b = 1. 444,SE = 0. 462,Wald χ2 = 9. 797,95% CI(1. 716,10. 475), HR = 4. 240,P = 0. 002〕. Conclusion PMME has high malignancy degree and poor prognosis;common manifestation under esophagoscope is gray black mass or overlying filthy gray black moss like mass in esophagus lumen;pathological staging is an independent influencing factor for the prognosis of patients;radical resection should be the primary therapy,and postoperative adjuvant chemoradiotherapy has no obvious influence on survival time.%目的：探讨食管原发性恶性黑色素瘤（PMME）的临床特点、治疗方法及预后。方法选取1993年3月—2014年1月在河北医科大学第四医院行手术治疗的17例 PMME 患者，记录其临床症状、实验室检查结果和治疗方法，并观察其预后。采用 Kaplan - Meier 法计算生存率，使用 Cox 回归模型进行预后分析。结果17例患者病理分期Ⅰ期4例，Ⅱ期7例，Ⅲ期6例；术后11例患者发生淋巴结转移，6例患者无淋巴结转移。患者肿瘤均位于食管中下段。食管镜检查示食管腔内灰黑色（8/17）或上覆污秽灰黑苔（5/17）肿物。患者均行食管癌切除、食管胃吻合术并清扫淋巴结，手术切除率为100％，术后应用辅助治疗11例，无辅助治疗6例。患者平均生存期为23.5个月，中位生存期为16.0个月，1、3、5年生存率分别为58.8％、17.7％、11.8％。不同病理分期患者生存曲线比较，差异有统计学意义（χ2＝12.150，P ＝0.002）。未发生淋巴结转移与发生淋巴结转移者生存曲线比较，差异有统计学意义（χ2＝8.855，P ＝0.003）。术后接受辅助治疗者与未接受辅助治疗者生存曲线比较，差异无统计学意义（χ2＝0.049，P ＝0.824）。多元 Cox 回归分析结果显示，病理分期是 PMME 患者生存预后的独立影响因素〔 b ＝1.444，SE ＝0.462， Wald χ2＝9.797，95％ CI（1.716，10.475），HR ＝4.240，P ＝0.002〕。结论 PMME 恶性程度高，预后差；食管镜检查示食管腔内灰黑色或上覆污秽灰黑苔肿物；病理分期是患者预后的独立影响因素，根治性手术切除是首选治疗方法，术后辅助放化疗对生存期未见明显影响。
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