Malignant melanoma of the mandibular gingiva: A rare occurrence

Abstract

Primary mucosal malignant melanoma of the oral cavity is a rare tumor. It accounts for only 0.2-8% of all malignant melanomas. This malignancy commonly affects male subjects and is more frequently seen on the hard palate and maxillary gingiva. The peak age for diagnosis of oral melanoma is between 55 and 65 years. A biopsy is required to establish a diagnosis. Ablative surgery with tumor-free margins remains the treatment of choice. It has a much poorer prognosis than its counterpart on the skin. Here, we present a case of malignant melanoma of the mandibular lingual gingiva in a 55-year-old male patient. Immunohistochemistry and special stains were conducted for confirmatory diagnosis.

Rapidly enlarging mass following dental extraction

“…[23] The pigmentation of the lesion may vary from light brown to dark brown and from black to blue. In our case, the lesion presented as reddish black nodular growth (pigmented nodular).…”

“…Oral melanotic macule, melanoacanthoma, melanocytic nevi, smoking associated melanosis, postinflammmatory pigmentation, drug induced pigmentation and intraoral pigmentation associated with systemic diseases like Peutz-Jeghers syndrome, Cushing syndrome and Addison's disease have to be considered in the differential diagnosis of oral melanoma. [23712]…”

“…[12] Melanocytes are dendritic cells of neural crest origin that migrate to the basal layer of oral mucosa during embryogenesis. [23] Melanin, a pigment, produced by melanocytes is either phagocytosed or deposited into adjacent epithelial cells. [4] A melanocyte and the group of epithelial cells that it provides with melanin are collectively described as epithelial-melanin unit.…”

Solitary Pigmented Melanocytic Lesion on the Palatal and Gingival Mucosa: Should It Rise Dentist’s Concerns?

“…2 The diagnosis of lesions with "no or low suspicion of malignancy" such as oral manifestation of systemic disease, physiologic pigmentation, smoker's melanosis, may be made based on clinical information alone or may need histopathological assessment. 2,3,5 Eral, the pigmented lesions in the oral cavity are benign in nature, which required no treatment unless discomfort is present. However, special concerns have to be put on OMM.…”

“…Therefore, in some cases, the histopathology and sometimes immunohistochemistry examination may be required. 3,5 In order to help clinicians to do a diagnostic pathway when finding pigmented lesions in the oral cavity, a flowchart for diagnosis and management of oral pigmented lesion had been proposed ( Figure 5). 2 When ones have classified the lesion to be melanocytic-related, clinical suspicion of malignancy in terms of ABCD checklist (asymmetry, border irregularities, color variegation and diameter > 6mm), recent history, age and the involved subsites should be assessed.…”