Primary malignant melanoma of the oral cavity: case report

Abstract

An 80-year-old-female patient had a pigmented lesion on: the hard palate, the soft palate, the alveolar mucosa and the vestibular mucosa of the maxillary gingiva. Pigmented macules and patches had been persistent and asymptomatic for many years (Fig. 1). The lesion exhibited irregularities of pigmentation, border and surface contour. About 1 year later the patient had noticed an extension of the pigmented macules and plaques; there was also the appearance of nodules of the maxillary gingiva accompanied by swelling. Loosening of teeth as a result of extensive destruction of bone was further noted (Fig. 2). The histological examination showed a downward streaming in the dermis of the tumor cells and a disintegration and ulceration of the epidermis (Fig. 3). An increased number of large round or polygonal cells resembling atypical epithelioid cells were found on the submucosa. The atypical cells had enlarged, pleomorphic nuclei with prominent and sometimes multiple nucleoli. Mitoses were observed at various tissue levels (Fig. 4). Abundant pigmented melanin was present in the tumor cells (Fig. 5). Many cells had fine, dusty melanin particles. The tumor cells showed great variations in size. Immunohistochemical staining, with S100 protein and HMB45 antibodies, stained many of the spindleshaped cells, indicating that they were melanocytic cells. An inflammatory infiltrate of lymphocytes was seen in a band beneath the invading tumor cells.

Monster Cells in Malignant Melanoma

“…The term ''pleomorphic'' has been invoked most often in describing melanomas arising outside the skin, typically in the CNS and mucous membranes of the head and neck. [24][25][26][27][28] Some authors have used this word to describe the histologic features of tumor cells 28 whereas others have invoked it as a pathologic subtype of melanoma. [24][25][26] Brat et al 27 termed these ''anaplastic'' melanomas.…”

“…Accompanying photomicrographs have demonstrated cell nuclei comparable to the monster cells noted in our cases. [25][26][27][28] Tumor cells have usually stained positively for typical melanoma markers such as S-100, NKI-C3, and HMB-45. Lodding and co-workers 29 reported 21 cases of metastatic cutaneous melanoma simulating soft tissue sarcomas.…”

Primary malignant melanoma of the oral cavity: a case report

“…Recognition of the lesion is possible when the overlying epithelium breaks down, with the presence of hemorrhage or identification of a growing mass. The most common late symptoms are ulceration, swelling, loosening of the teeth, and ill‐fitting dentures 2,6,14 . This delayed detection partially accounts for the poor prognosis of oral melanoma 2…”

Seltener Fall einer Zahnwurzelinfiltration durch ein metastasierendes malignes Melanom der Mundhöhle

“…Zu den klinischen Sonderformen der malignen Melanome gehören die extrakutanen, die amelanotischen Melanome, sowie die Schleimhautmelanome, die etwa 5% aller Melanome ausmachen [4]. Maligne Melanome, die in 30-60% aller Schleimhautmelanomfälle in der Mundhöhle vorliegen, zeigen seltener und vergleichsweise spät knöcherne Osteolysen [2,8] …”