Primary malignant melanoma of the esophagus (PMME) is a highly aggressive tumor with a poor prognosis. Here we describe the case of an 87-year-old man who presented with poor appetite, dysphagia, hematemesis, and weight loss. He had a history of primary malignant melanoma of the esophagus 5 years ago. PMME with hemorrhage and anemia were diagnosed by the esophagogastroduodenoscopy (EGD). After hemostatic medications, the hemorrhage in the esophagus was successfully controlled. The patient refused further surgery or radiotherapy, and he chose palliative care. This article reported a rare case with PMME with hemorrhage, and the findings of the morphological changes of the PMME from a flat-type melanoma to a bulging tumor during a 5-year period are extremely rare.  (J Intern Med Taiwan 2021; 32: 297-300)