Objective: To analyze the pathological characteristics, differential diagnosis, biological behavior and prognosis of primary malignant melanoma of the esophagus (PMME). Methods: Five cases of PMME in Anyang Tumor Hospital were collected and analyzed by microscopy, immunohistochemical staining, clinical pathology analysis and followed up. Results: PMME is more common in the elderly, it often occurs in the middle of esophagus, generally mushroom umbrella. Under microscope the tumor cell showed atypia, spindle-shaped, oval or irregular, with shuttle shaped cells. Bulky tumor cell nuclei, prominent nucleoli, abundant chromatin. Various forms of tumor cells and non-pigmented was misdiagnosed as poorly differentiated squamous cell carcinoma, sarcomatoid carcinoma, lymphoma and so on. Immunohistochemistry of tumor cells showed positive in vimentin, S-100, HMB-45 and Melan-A; do not express neuron-specific enolase (NSE), leukocyte common antigen (LCA), cytokeratin (CK), chromogranin proteins A (CgA) and synaptophysin (syn). Infiltration of tumor cells with different organizational levels may be associated with lymph node metastasis. Conclusion: PMME is a rare tumor, with high malignancy and poor prognosis. Due to its symptoms similar to other esophagus cancer, it’s difficult to be diagnosed before biopsy or surgery, to those esophageal fungating tumors occurred in the elderly, the primary malignant melanoma should be considered. The clinical pathological analysis of tumor size, invasive level, lymph node metastasis and treatment may influence prognosis.