Tumor Size and Depth in Primary Malignant Melanoma in the Oral Cavity Influences Survival

Primary Oral Mucosal Melanomas – Two Case Reports and Comprehensive Literature Review

“…Most melanomas of the mucosa of the head and neck at the time when they are presented, are in stage I. Prasad et al 12 defi ned this status using a 3-level micro-staging system, which represents diff erent micro-anatomic spaces of the separate tissue barriers. Th ese are a signifi cant predictor related to 5-year survival 12,13 . Th e American Joint Committee on Cancer (AJCC) Melanoma Staging Committee, in its already existing guide to melanoma, updated the criteria in the fi nal version of the Tumor-Node-Metastasis (TNM) classifi cation of melanoma 14 .…”

“…Destruction of any barrier (boundary) of that space correlates with progressive deterioration of survival rates. Stage I has 3 levels: Level 1, in situ mucosal melanoma or microinvasion: Level 2, invasion restricted to the lamina propria; and Level 3, melanoma with deep invasion into the neighboring tissue, such as bone (in the oral mucosa), cartilage (in the larynx), or skeletal muscle 12,13 . Th e superfi cial architecture of oral melanomas is seen in macular, ulcerous or nodular forms.…”

Surgical Decision Making in Oral Mucosal Melanoma with Lymphadenopathy: Review of Literature

“…16,17 The surgical resection within oral cavity remains problematic because wide resection margins require also reconstruction technique after tumor ablation to avoid mutilation, functional impairment and poor quality of life. [18][19][20] Regional lymph nodes are the most common sites of metastases for all melanomas. Palpable lymph nodes in neck or fixed to the adjacent tissues should be suspicious for metastases.…”

“…23 Patients who suffered from oral mucosal melanomas are often diagnosed at an advanced stage followed by ulceration, microsatellites or regional nodal metas tases. 10,11,18 This high rate of regional lymph node metas tases means that patients at risk should considered for therapeutic elective neck dissection with a low threshold for surgery. Although no randomized trials on the treatment of the regional lymph nodes for oral mucosal malignant melanoma exist due to its rarity of this tumor, there is little doubt about this treatment approach.…”

“…Although no randomized trials on the treatment of the regional lymph nodes for oral mucosal malignant melanoma exist due to its rarity of this tumor, there is little doubt about this treatment approach. 18,23 As the OMMs are very aggressive and the texture of mucosa is different from the cutis with an earlier occurrence of lymph node metastases, there is actually no role of sentinel lymph node technique, as the risk of surgery and radiation than in patients receiving radiation alone (5 months).…”