Palatal Melanoma: ʺThe Silent Killerʺ

Abstract

Primary melanoma of the oral cavity is extremely uncommon tumour consisting approximately 0.2 - 8.0% of all melanoma cases and 0.5% of all oral malignancies. It has an aggressive behaviour and poor prognosis, with 5 – year - survival rate between 5 - 20%. The initial symptoms are often unnoticed, which lead to late diagnosis and worsening of the prognosis. Because of its infrequent occurrence, there is no well - defined classification and therapeutic protocol, in contrast to melanomas of another side. Early diagnosis and treatment are essentially linked to survival rate. We present a case of palatal melanoma in a 76 – year - old female patient, as we want to emphasise the importance of the early detection and accurate diagnosis of melanoma of oral cavity, to its influence of the therapeutic outcome.

Primary retromolar malignant melanoma in a Latin American patient

“…17 Some risk factors such as tobacco use and local chronic irritations have been associated with the occurrence of oral melanoma. 2,3,5 In the present case, the patient had smoked approximately 10 cigarettes per day for 20 years. The diagnosis of melanoma can be corroborated by positive immunohistochemistry staining results for S100, HMB-45, and Ki-67 (principally in non-melanotic melanomas); 9,10 in biopsy from our patient, strong staining was observed for HMB-45, a preferred marker for melanocytes.…”

“…3,12,13 Similar to the age of our patient, the age of onset of this melanoma ranges from 20 to 80 years (most commonly, 41-60 years); it also predominantly affects men (2:1 ratio, compared with women). 2,5 In the oral cavity, primary malignant melanomas comprise 6.3% of all melanomas localized in the head and neck area; 5 only approximately 0.7% to 1.6% of all melanomas originate in the oral mucosa. 1,6,12 Although there is no ethnic predilection or environmental factor that contributes to increased incidence of this neoplasm, individuals of African and Asian ethnicity are more commonly affected than individuals of Caucasian ethnicity.…”

“…[1][2][3] The etiology of this neoplasia is unknown, although it may arise from a preexisting benign melanocytic lesion or nevus. 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.…”

“…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. [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.…”

Treatment Modalities of Recurrent Oral Mucosal Melanoma In Situ

“…Oral melanoma, like other mucosal melanomas, normally has a bad prognosis with a high risk of recurrences [ 4 ]. Carcinogenic noxae, such as tobacco, but also various genetic mutations, are suspected to be risk factors for the development of oral mucosal melanoma (OMM) [ 1 , 5 ]. Dentists are often first to discover an OMM and can already make a clinical diagnosis if the OMM appears as a typical brown-to-blackish-pigmented nodule or macula [ 6 ].…”