The lesion was widespread Type 0-Ⅱb, and positron emission tomography (PET)/computed tomography (CT) showed no lymph node metastasis nor metastasis to other organs. Then, we determined that radical operation would be effective, and the patient underwent thoracoscopic subtotal esophagectomy in the prone position with three-field lymph node dissection. Microscopic findings of the resected specimen confirmed the presence of atypical cells with melanin deposition basally located in stratified squamous epithelium. Immunostaining revealed that atypical melanocytes had spread 16.4 centimeters in the longest diameter beyond the grossly visible blackish area. Dissected lymph nodes were negative for metastatic dissemination, and he was diagnosed with T1a-LPM N0M0; Stage 0.