Based on PubMed | Is difficulty swallowing a symptom of melanoma?

Difficulty swallowing (dysphagia) is not a common symptom of typical skin melanoma, but it can occur in specific situations especially when melanoma involves the mucous membranes (mucosal melanoma) of the mouth, throat, or esophagus, or when skin melanoma spreads (metastasizes) to the upper aerodigestive tract. In these cases, dysphagia may be a presenting or consequential symptom. ^{[1] [2] [3]}

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When Dysphagia Can Be Related to Melanoma

• Mucosal melanoma of the head, neck, or esophagus: Melanoma can arise in internal mucous membranes lining the mouth, nose, throat, and esophagus; when located in the throat or esophagus, it may cause swallowing difficulties due to mass effect, ulceration, or local invasion. This form is rare but can be mistaken for more common conditions, delaying diagnosis. ^{[1] [4]}

• Metastatic spread to the upper aerodigestive tract (UADT): Cutaneous (skin) melanoma can metastasize to areas such as the tonsils, tongue, nasopharynx, larynx, and esophagus, producing local symptoms including dysphagia. In historic series, airway obstruction and difficulty swallowing were notable local symptoms when the UADT was involved. ^{[3] [5]}

• Primary melanoma of the esophagus: Extremely rare, but well-documented; dysphagia is the most common presenting symptom, often with rapidly progressive swallowing difficulty and weight loss. Reports consistently describe dysphagia as the leading symptom in primary esophageal melanoma. ^{[6] [7] [8] [9]}

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Dysphagia From Cancer Treatments

• Radiation therapy to head and neck for melanoma: External beam radiation in the head and neck region can cause sore throat, pain with swallowing, xerostomia (dry mouth from salivary gland dysfunction), and difficulty swallowing due to mucosal irritation and salivary changes. Patients may benefit from dietary adjustments and speech/swallow therapy during radiation. ^{[10] [11]}

• Post‑radiation changes affecting chewing and swallowing: Radiation can lead to tissue and bone changes near the jaw, potentially causing difficulty opening the mouth, chewing, and swallowing; dental care considerations are important after head and neck radiation. Persistent mouth symptoms should be discussed with clinicians and dentists. ^[12]

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How Common Is Dysphagia in Melanoma?

• Typical skin melanoma: Most early skin melanomas present as changing skin lesions (color, border, size) rather than swallowing problems. Dysphagia is not a hallmark of cutaneous melanoma unless deeper structures are involved or disease has spread. ^[13]

• Rare internal melanomas: Mucosal melanoma accounts for about 1% of all melanomas and may show location-specific symptoms; when it involves the head, neck, or esophagus, swallowing difficulty can occur. Because mucosal melanoma is uncommon and subtle, symptoms are often misattributed to more common ENT or GI issues. ^{[14] [15] [16]}

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Red Flags That Merit Medical Evaluation

• New or progressive dysphagia: Trouble swallowing solids progressing to liquids, food sticking, pain with swallowing, or unexplained weight loss warrant prompt evaluation. These can reflect esophageal or oropharyngeal disease, including rare melanoma involvement. ^{[6] [7]}

• Associated head and neck symptoms: Persistent sore throat, voice changes, gurgling, coughing on swallowing, mouth ulcers, or neck lumps alongside dysphagia should be assessed especially in people with a melanoma history. Local examination and endoscopy can be necessary to rule out metastatic or mucosal disease. ^{[3] [17] [15]}

• After head and neck radiation: Ongoing difficulty swallowing or chewing after radiation should be reviewed; supportive care (speech pathology, dietetics) and symptom management can improve safety and nutrition. Simple strategies moistening foods, avoiding irritants, upright posture may help. ^{[10] [11]}

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Recommended Work‑Up If Dysphagia Is Present

• Clinical exam: Head and neck examination including oral cavity, oropharynx, and neck nodes can identify masses or mucosal lesions. Targeted evaluation is important in anyone with a personal history of melanoma. ^[3]

• Endoscopic assessment: ENT nasopharyngolaryngoscopy or gastroenterology esophagogastroduodenoscopy (EGD) can visualize and biopsy suspicious lesions in the throat or esophagus. Biopsy is required for diagnosis, as mucosal melanoma can mimic other conditions. ^{[18] [6]}

• Imaging: Cross‑sectional imaging (CT/MRI) and PET-CT may be indicated if a lesion is found or if metastatic disease is suspected. Imaging helps stage disease and guide treatment planning. ^[3]

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Treatment Considerations

• Localized mucosal or esophageal melanoma: Surgical resection is often pursued when feasible, sometimes with adjuvant radiation. Outcomes vary and tend to be less favorable than skin melanoma due to aggressive behavior and advanced stage at diagnosis. ^{[6] [7]}

• Metastatic lesions causing obstruction: Local endoscopic or surgical interventions may be used to relieve airway or esophageal obstruction and improve swallowing, alongside systemic therapy for melanoma. Palliation can be necessary to maintain nutrition and airway safety. ^{[3] [18]}

• Supportive care during radiation: Nutrition support, swallowing therapy, and symptom-focused measures can reduce dysphagia and treatment-related discomfort. Care teams often advise diet modification and specialist input during head and neck radiation. ^{[10] [11]}

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Quick Reference Table: Dysphagia and Melanoma

Scenario	Likelihood of Dysphagia	Typical Cause	Key Actions
Early cutaneous melanoma	Low	Skin lesion only	Skin exam; monitor ABCDE changes. [13]
Mucosal melanoma (head/neck, esophagus)	Moderate to high (location-dependent)	Primary tumor in mucosa causing mass effect/ulceration	ENT/GI evaluation, endoscopy, biopsy, imaging. [1] [4] [6]
Metastatic melanoma to UADT	Moderate	Secondary deposits causing obstruction	Urgent local exam, endoscopy; consider palliation and systemic therapy. [3] [5]
Head/neck radiation effects	Variable	Mucosal inflammation, salivary dysfunction, tissue changes	Symptom management, diet changes, speech/swallow therapy. [10] [11] [12]

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Bottom Line

• Dysphagia is not a typical symptom of early skin melanoma, but it can occur in rare internal melanomas of the throat or esophagus and when skin melanoma spreads to the upper aerodigestive tract. ^{[1] [3]}
• Treatments for head and neck melanoma, such as radiation, can also cause difficulty swallowing, often temporarily but sometimes persistently, requiring supportive care. ^{[10] [11]}
• Any new or worsening trouble swallowing especially in someone with a current or past melanoma diagnosis deserves prompt medical evaluation to rule out mucosal involvement, metastasis, or treatment-related complications. ^{[3] [6] [10]}

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