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Intraoral periapical radiograph of the maxillary left first and second molars showing irregular widening of the periodontal ligament space apical to the maxillary left first molar.
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Malignant melanoma is a neoplasm of melanocytic origin that arises from a benign melanocytic lesion or de novo from melanocytes within otherwise normal mucosa or skin. Melanoma arising from the mucosal surfaces of the head and neck is a very rare disease and is considered among the most deadly of all human neoplasms. Although it comprises 1.3% of a...
Citations
... A literature search indicates that host-immune-mediated responses, particularly the CD8-positive Cytotoxic T Lymphocytes (CTLs) play a significant role in the development of regression. The role of the immune system in regression is further supported by the high incidence of CD4positive T lymphocytes and Th1 cytokines in regressed tumours, as well as the high levels of tumour-specific antibodies and CTLs in the peripheral blood of patients with regressed tumours [8][9]. ...
Introduction Primary Mucosal melanomas of the head and neck region are a rare kind of malignancy arising from the melanocytes. The primary melanomas of the paranasal sinuses are extremely unusual and associated with a poor prognosis due to delayed diagnosis. These lesions tend to metastasize and locally invade tissues more than any other malignant tumour of the head and neck region. Case report Here, we present a case of a fifty-seven-year-old male who presented with epistaxis and nasal obstruction. Imaging revealed a soft tissue mass lesion involving the maxillary sinus and nasal cavity with erosion of the floor of right orbit. Discussion The mainstay of treatment for these sinonasal mucosal melanomas is surgical resection followed by adjuvant radiotherapy or
... A literature search indicates that host-immune-mediated responses, particularly the CD8-positive Cytotoxic T Lymphocytes (CTLs) play a significant role in the development of regression. The role of the immune system in regression is further supported by the high incidence of CD4positive T lymphocytes and Th1 cytokines in regressed tumours, as well as the high levels of tumour-specific antibodies and CTLs in the peripheral blood of patients with regressed tumours [8][9]. ...
Introduction- Primary Mucosal melanomas of the head and neck region are a rare kind of malignancy arising from the melanocytes. The primary melanomas of the paranasal sinuses are extremely unusual and associated with a poor prognosis due to delayed diagnosis. These lesions tend to metastasize and locally invade tissues more than any other malignant tumour of the head and neck region.
Case report- Here, we present a case of a fifty-seven-year-old male who presented with epistaxis and nasal obstruction. Imaging revealed a soft tissue mass lesion involving the maxillary sinus and nasal cavity with erosion of the floor of right orbit.
Discussion- The mainstay of treatment for these sinonasal mucosal melanomas is surgical resection followed by adjuvant radiotherapy or chemotherapy. However, the prognosis of these lesions is poor with a 5-year survival rate of only 15-16 %.
... Surgery remains the mainstay of treatment along with chemotherapy, radiotherapy, and immunotherapy. In the cases where metastasis has already occurred the disease is well as the high levels of tumour-specific antibodies and CTLs in the peripheral blood of patients with regressed tumours [8,9]. Clinicians must carefully examine the oral cavity and any growing pigmented lesion must be biopsied. ...
Primary mucosal malignant melanoma of oral cavity is a rare malignancy arising from the melanocytes. Mucosal melanomas of the head and neck comprise just over 1% of all melanomas and of these about 50% arise in the oral cavity. Oral mucosal melanomas are therefore rare, representing about 0.5% of oral malignancies and less than 0.01% of all oral biopsies. It tends to metastasize and locally invade tissues more than other malignant tumours of the oral cavity. It occurs commonly in the maxillary gingiva more frequently on the palate and lesser often in the mandibular gingiva. Here, we present a case of a mucosal malignant melanoma involving the maxillary bone along with the immunohistochemical profile of the neoplasm.
... Few of the cases have been described in the mandibular region as well. [1][2][3][4]8,9 Most cases of oral melanoma occur between third and seventh decade of life with a mean age of 45-60 years 1-3 and a slight male predilection has been reported. 5 Oral melanoma accounts for 1-2% of all oral malignancies 1,4 and 1.6% of all the malignancies in head and neck region. ...
... 7 With a previous known record of poor prognosis, patients exhibiting primary oral melanomas presenting with features such as tumor thickness greater than 5 mm, displaying vascular invasion, necrosis, polymorphous tumor cell morphology and the inability to properly resect these lesions with negative margins are associated with low survival rates. 7 Gingival melanoma has an improved 5-year survival rate than palatal melanoma 8 and recurrences have been reported even 10-15 years after the primary therapy. Distant metastases to the lungs, brain, liver, and bones has also been observed in many instances. ...
Introduction: Primary malignant melanoma of the oral cavity is a rare neoplasm that arise from a benign melanocytic lesion or de novo from melanocytes within otherwise normal skin or mucosa. Melanoma is third most common skin cancer, but it account for only 5% of the total. The tumors tend to metastasize or locally invade tissue more readily than other malignant tumors in the oral region. The survival of patients with mucosal melanomas is less than for those with cutaneous melanomas. Tumor size and metastases are related to the prognosis of the disease. Early detection, therefore is important.
... 4,5 It is painless in its early stages, with asymmetric and irregular contour. 6 Diagnosis is often delayed, and is only made when symptoms manifest as a result of ulceration or growths. The melanoma becomes a strongly pigmented tumor, sometimes ulcerated and hemorrhagic, which tends to increase in size. ...
... Within the oral cavity, the most frequently affected sites include the palate and maxillary gingiva; combined, these sites exhibit 80% of all melanomas in the oral cavity. 4,6,[10][11][12][13] The remaining melanomas are found in the mandibular gum, oral mucosa, tongue, and floor of the mouth. 5 Primary melanoma of the oral mucosa occurs frequently among individuals of Asian and African ethnicities, partially in relation to the high frequency of melanic pigmentation in the oral mucosa. ...
... 5 Primary melanoma of the oral mucosa occurs frequently among individuals of Asian and African ethnicities, partially in relation to the high frequency of melanic pigmentation in the oral mucosa. [1][2][3]6,11 To the best of our knowledge, primary malignant melanoma has scarcely been reported in patients from Latin America; reports of this subtype of melanoma are important for accurate diagnosis and treatment of Latin American individuals. Here, we describe primary retromolar malignant melanoma in a Latin American patient. ...
Primary malignant melanoma of the oral mucosa is rare and has scarcely been reported in patients from Latin America. The most frequently affected sites include the palate and gingiva of the maxilla. In this report, we describe primary malignant melanoma in a Latin American patient. A 3 × 3.5-cm black tumor was observed on the upper left retromolar area. The lesion exhibited a sessile base, irregular edges, soft consistency, and pain on palpation. Immunohistochemistry staining results were positive for S100 and HMB-45; the Ki-67 index was 20%. Contrast tomography of the skull, face, abdomen, and thorax, as well as ultrasound of the liver, did not reveal metastatic lesions. The patient underwent wide surgical excision of the lesion, followed by radiotherapy; he was subsequently rehabilitated with a somato prosthesis.
... 1,2 Malign melanomlar, oral kavitede görülen nadir lezyonlardır ve rapor edilen vakaların % 80'inde çoğunlukla maksiller gingiva, sert damak ve alveol kretinde görülmekte, yaklaĢık % 20'sinde ise mandibulada lokalize olarak görülmektedirler. [3][4][5][6] Malign melanomların birçoğu normal mukoza görünümüne sahiptir. 7 Oral melanomların ağız içi klinik bulgularında; asimetrik ve düzensiz sınırlı 6 mm'den ...
... 2 Accordingly, the low concentration of melanocytes within the oral mucosa may explain the rare occurrence of OM. 3 In fact, OM accounts for 0.2% to 8.0% of all melanomas and 0.5% of all oral malignancies. 4,5 Nonetheless, the etiological factors involved in the development of OM or the function of mucosal melanocytes have still not been well established. 3 Clinically, OM can present as a pigmented or amelanotic (nonpigmented) lesion, 3 occurring mainly in the maxillary alveolar mucosa and palate of elderly men. ...
Objective:
The purpose of this manuscript is to present a clinicopathologic review of the literature concerning all the detailed cases of primary oral melanoma (OM) that were confirmed by immunohistochemistry. In addition, a pertinent case presentation is addressed.
Data sources:
An extensive electronic search of the literature was performed using PubMed/Medline from 1953 to 2017. Relevant articles were selected based on specific inclusion criteria. Statistical analyses were conducted by the Shapiro-Wilk, Fisher's exact, chi-square, and Z tests (α = .05).
Results:
Forty-nine cases of primary OM reported in the literature plus the current case were analyzed; patient ages ranged from 17 to 89 years with a mean of 60.8 years; male to female ratio was 1.5:1; Caucasian patients were the most affected and the most frequent locations were maxillary alveolar mucosa and palate; the majority of the lesions were pigmented (62%); differences among the proportions of positivity to S-100, HMB-45, Melan-A, NKFC3, vimentin, tyrosinase, CK, microphthalmia transcription factor (MITF), and Ki-67 were found (P < .0001), especially when comparing with vimentin (P < .05) and CK (P < .01); recurrence was reported in 11.6% and mortality in 54.8%. The case presented is of a 71-year-old mixed-race woman who presented multiple pigmented lesions over the maxillary alveolar mucosa and palate. Positivity for S-100, HMB-45, Melan-A, and Ki-67 confirmed the diagnosis of primary OM.
Conclusion:
Primary OM is rare and very aggressive, with only 49 detailed cases confirmed by immunohistochemistry existing within the English literature, in addition to the present case. S-100 and HMB-45 are excellent markers to confirm the diagnosis of primary OM, although the use of adjuvant specific markers such as Melan-A, tyrosinase, and MITF should be also encouraged.
... Primary oral melanomas originate either from a nevus or preexisting pigmented lesion, currently most thought to arise de novo. [9][10][11] The mucosa of the upper jaw accounts for nearly 80% of oral melanomas, with the keratinizing mucosa of the palate and the alveolar gingiva being the most common sites of occurrence. [12] The disease has a male preponderance (male-to-female ratio 2.8:1) and the age range is 20-83 years with an average age of 56 years. ...
... Radiotherapy and chemotherapy are used as adjunctive treatment modalities. [9] Surgical exploration forms the cornerstone for the management of malignant melanoma, and vigorous surgical extirpation of local disease may result in extended disease-free survival. [23,24] However, preoperatively confirmed cases of lymph node metastases should be managed with neck dissection. ...
Melanoma is one of the most dreaded and aggressive neoplasms, being derived from epidermal melanocytes. The majority of melanomas are seen to involve the skin, and primary mucosal melanomas account for less than 1% of all melanomas. Oral malignant melanomas (OMM) are asymptomatic at the initial presentation, but later they become painful with growth and expansion. In the late stages, the patient may present with ulceration, bleeding, tooth mobility, paresthesia, ill‑fitting prosthesis, and delayed healing of the extraction sockets. Diagnosis is often delayed due to asymptomatic clinical presentation, with silent progression of the lesion. OMM are associated with poor prognosis due to their invasive and metastasizing tendencies. The condition has poor survival rates, and metastatic melanomas show even worse prognosis. The 5‑year survival rate for OMM ranges 4.5–29%, with 18.5 months being the mean survival rate. The tumor is best managed by wide surgical resection; however, consideration should also be made for adjunctive therapies such as chemotherapy, immunotherapy, and radiotherapy. Recurrences may be seen even 10–15 years after the primary therapy. This paper aims to present an interesting report of aggressive OMM in a 50‑year‑old male patient and emphasizes the role of dental professionals in maintaining a high degree of vigilance for the pigmented lesions of the oral cavity. Pigmented lesions of uncertain origin should be routinely biopsied to rule out malignancy. Early diagnosis of this dreadful entity entails thorough history taking, physical examination, and radiographic features coupled with histopathology.
... OMM, which was first described by Weber in 1859, is a much rare neoplasm located at the basal layer of the oral mucous membranes owing to the uncontrolled growth of melanocytes [11]. Mucosal melanoma accounts for only 0.5 % of all oral tumor involving the sinonasal cavity, oral cavity, pharynx, larynx, and upper esophagus [12]. ...
Oral malignant melanoma (OMM) is an aggressive tumor with very low survival rate and easy to metastasize. Pleural metastatic melanoma via primary OMM is rare.
Case presentation
In this report, we presented a case of metastatic malignant melanoma of the pleura originated from OMM. A 54-year-old man without primary skin lesion was diagnosed multiple nodular shadows, pleural invasion, and pleural effusion by chest computed tomography (CT). One cyst-form tumor on the tongue base was observed by bronchoscopy, which was diagnosed as OMM by pathological examination and then was resected. After getting the tumor tissues from the pleura by pleural biopsy surgery, the diagnosis of pathological examination was pleural metastatic melanoma. Furthermore, tumor cells displayed a positive immunoreaction for melanocytic markers S100 and HMB-45 combining with positive vimentin and cytokeratin AE1/AE3. The patient was therefore diagnosed with metastatic melanoma of the left pleura and the primary melanoma was OMM.
According to this case, we could draw the conclusion that pleural metastasis from OMM was very rare and thoracoscopy preceded under local anesthesia is an important method for its accurate diagnosis.
... 24 Malign melanomlar, oral kavitede görülen nadir lezyonlardır ve rapor edilen vakaların %80'inde çoğunlukla maksiller gingiva, sert damak ve alveol kretinde görülmekte, yaklaĢık %20'sinde ise mandibulada lokalize olarak görülmektedirler. [25][26][27][28][29][30] Bizim vaka raporumuzda da literatürle uyumlu olarak malign melanom sert damakta lokalize durumdaydı. ...
Öz
ÖZET
Bu vaka raporunun amacı, sert damakta lokalize malign melanomun klinik ve radyolojik özelliklerini sunmaktır.
Protez vuruğu şikayetiyle fakültemize başvuran 65 yaşında erkek hastanın yapılan klinik muayenesinde sert damağında lokalize, ülsere, kanamalı lezyon tespit edildi. Kesin tanı koyabilmek için hastadan insizyonel biopsi alındı.
Histopatalojik olarak malign melanom teşhisi koyulan hastaya cerrahi operasyon önerildi. Cerrahi tedaviyi kabul etmeyen hastaya semptomatik tedavi yapıldı.
Malign melanom, oral kavitede nadir olarak görülen kötü prognoza sahip agresif bir tümördür.
Anahtar Kelimeler: Melanom, sert damak, oral kanser
ORAL MALIGNANT MELANOMA: CASE REPORT
ABSTRACT
The purpose of this case report is to present clinical and radiological features of malignant melanoma which localized in the hard palate.
65-year-old male patient with prosthes trauma complaint referred to our faculty, ulcerated and bleeding lesion localized in the hard palate was detected by clinical examination. Incisional biopsy was taken from the patient to a definitive diagnosis.
Histopathologically, malignant melanoma was diagnosed, surgical operation was recommended. But patient refused the surgical treatment so symptomatic treatment was performed.
Malignant melanoma is an aggressive tumor with a poor prognosis are rarely seen in the oral cavity.
Key Words: Melanoma, hard palate, oral cancer
