Primary malignant melanoma of oral cavity: A tertiary care center experience

Abstract

Background:Primary mucosal malignant melanoma is an extremely rare, aggressive neoplasm accounting for 0.5% of all oral malignancies. Any pigmented lesion in oral cavity should have an index of suspicion, which should be investigated to detect the disease at an early stage and managed appropriately. Melanomas tend to invade locally into the tissue or metastasize more commonly than other malignant tumors of the oral cavity.Materials and Methods:We report a retrospective case series of eight patients suffering from primary oral malignant melanoma treated in our department between 2012 and 2014. The details were recorded from the departmental computerized database and patients on follow-up.Results:There were six male and two female patients with a mean age of 46.8 years. Hard palate was the most common affected site in oral cavity. Pigmented lesion\ulcer was the most common presenting symptom. Majority of patients (5 patients) were diagnosed with Stage III (distant metastasis), two patients in Stage II, and one patient in Stage I. Three patients were treated with definitive surgery and five patients with palliative chemotherapy in view of distant disease. Following surgery, two of them required adjuvant chemoradiotherapy in view of nodal spread. Patients had a mean follow-up of 10.5 months (range: 8–26 months). Patients treated with definitive surgery had a mean survival rate of 16 months (range: 10–26 months), with local recurrence in one patient. Metastatic melanoma patients treated with palliative chemotherapy had a mean disease control rate of 5 months (range 5–9 months).Conclusion:Oral melanoma carries dismal prognosis with a 5-year survival rate of 5–20%. Early detection of the lesion, proper evaluation, and appropriate treatment are very important to cure the disease.

Palatal Melanoma: ʺThe Silent Killerʺ

“…Although extremely rare and aggressive in behavior, due to rapid hematogenous and lymph node metastatic spread, melanoma of the oral cavity could be asymptomatic flat macule for a long time (9). Because of its infrequent occurrence, there is no well -defined classification and therapeutic protocol, in contrast to melanomas of other side [ 2 ][ 3 ]. Although several authors team have been proposed different clinical and histological classification systems, unified criteria are not accepted worldwide.…”

“…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 [ 1 ][ 2 ]. It has been called “a silent killer”, because of its highlighted aggressive behaviour and early metastatic spread [ 1 ][ 3 ].…”

“…Although chronic irritation, tobacco, alcohol and formaldehyde exposure have been implicated as possible risk factors, it is considered that most of the melanomas of oral cavity arise de novo [ 4 ]. In contrast to cutaneous melanoma, no particular precursor lesion has been identified, and atypical melanocytic hyperplasia is considered as a proliferative phase [ 2 ]. Despite blue nevi, dysplastic nevi involve the oral cavity extremely rare, most often – the palate mucosa [ 5 ].…”

“…Patients usually seek medical help because of bleeding, pain or swelling, which are associated with vertical growth phase and progression of the disease [ 6 ][ 7 ]. Furthermore, because of the anatomic structure of the oral cavity, bone invasion and destruction are commonly seen in cases of melanoma of the hard palate [ 2 ].…”

“…Surgery is the first choice of treatment which often require subsequent reconstruction of the defects and advanced cases [ 3 ][ 4 ]. However, the 5 -year - survival rate in advanced cases with bone destruction varies between 5 - 20% and only 6.6% more than five years, which emphasise the underhanded aggressive nature of this kind of tumours [ 2 ][ 7 ][ 8 ].…”