Malignant melanoma is a highly malignant tumor that originates from melanocytes and is found in the skin, eyes, mouth and anus. Esophagus is a rare site for melanoma to occur, and literature reports that esophageal melanoma accounts for 0.1%-0.29% of all malignant tumors in the esophagus, which is usually found in the middle and lower esophagus. The diagnosis of melanoma can be easily made by gastroscopy, but some melanomas are not obvious in terms of melanin deposition, so it is difficult to distinguish them from cancer, and they are often misdiagnosed by gastroscopy. In this case, the diagnosis was made clearly because of the obvious microscopic features. The suspected diagnosis of esophageal hemangioma by gastroscopy may be related to the operator’s lack of knowledge about this disease. It is not difficult to differentiate the extent of the lesion and texture of the mass from hemangioma in this case. The diagnosis of primary malignant melanoma in the esophagus is still controversial, but Allen et al. first suggested that primary melanoma in the esophagus can be considered when the following four conditions are met: 1) it has the characteristic structure of melanoma and contains melanin deposits; 2) melanocytes are visible in the adjacent epithelium; 3) the tumor is polypoid; and 4) it originates from a junctional area of activity within the squamous epithelium. However, due to the large size of the tumor, the junctional phenomenon and the activation of melanocytes in the adjacent epithelium often cannot be confirmed. At present, if there is no clear clinical evidence suggesting lesions in other melanoma-prone organs, esophageal melanoma is diagnosed as the primary.