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fucosal melanomas of the oral cavity are rare, representing about 0.5% of oral malignancies Speight PM (2005).  Mucosal malignant melanoma. In: Barnes L, Eveson JW, Reichart P, Sidransky D eds.  Pathology & Genetics. Head and Neck tumours, Lyon, IARC Press, 206-207.. They arise in middle-aged adults, with a male predominance Prasad ML, Patel S, Hoshaw-Woodard S, Escrig M, Shah JP, Huvos AG, Busam KJ (2002). Prognostic factors for malignant melanoma of the squamous mucosa of the head and neck. Am J Surg Pathol 26: 883-892.. These tumours are more common in dark-skinned races and in Japanese Umeda M, Mishima Y, Teranobu O, Nakanishi K, Shimada K (1988). Heterogeneity of primary malignant melanomas in oral mucosa: an analysis of 43 cases in Japan. Pathology 20: 234-241.Lopez-Graniel CM, Ochoa-Carrillo FJ, Meneses-Garcia A (1999). Malignant melanoma of the oral cavity: diagnosis and treatment experience in a Mexican population. Oral Oncol 35: 425-430.Rapini RP, Golitz LE, Greer RO, Jr., Krekorian EA, Poulson T (1985). Primary malignant melanoma of the oral cavity. A review of 177 cases. Cancer 55: 1543-1551.. No etiological factors have been identified. These tumours arise more commonly on the palate and maxillary gingivae Stewart BW, Kleihues P, eds, (2003). Head and Neck Cancer. In:.  World Cancer Report, Lyon, IARC Press, 232-236.Lopez-Graniel CM, Ochoa-Carrillo FJ, Meneses-Garcia A (1999). Malignant melanoma of the oral cavity: diagnosis and treatment experience in a Mexican population. Oral Oncol 35: 425-430.. Clinically, they appear as black, grey or purple to red mass or growth and rarely as amelanotic macular lesions with areas of nodular growth. Ulceration and invasion of adjacent bone is seen in advanced cases. These tumours are very aggressive and the prognosis is poor. The majority of these patients present in advanced stage with involvement of cervical nodes, and 50% may have distant metastases to the lung or liver. Diagnosis is confirmed by biopsy.

Differential diagnosis:



Radical surgical removal is the treatment of choice. Post operative radiotherapy has improved local control even for smaller tumours, but with no impact on survival Temam S, Mamelle G, Marandas P, Wibault P, Avril MF, Janot F, Julieron M, Schwaab G, Luboinski B (2005). Postoperative radiotherapy for primary mucosal melanoma of the head and neck. Cancer 103: 313-319.Mendenhall WM, Amdur RJ, Hinerman RW, Werning JW, Villaret DB, Mendenhall NP (2005). Head and neck mucosal melanoma. Am J Clin Oncol 28: 626-630.. Radical radiotherapy is considered in cases where surgery is not feasible. Chemotherapy and immunotherapy have not improved survival. Overall survival is poor, with a 5-year survival of around 20% Temam S, Mamelle G, Marandas P, Wibault P, Avril MF, Janot F, Julieron M, Schwaab G, Luboinski B (2005). Postoperative radiotherapy for primary mucosal melanoma of the head and neck. Cancer 103: 313-319..


ImageLegend
Figure 1: Malignant melanoma of the floor of mouth. Note the extensive black mass with a nodular surface involving the lower labial sulcus extending to the floor of mouth.
Figure 2: Extraoral photograph of the same patient showing enlarged metastatic lymph node in the right submanbular region.
Figure 3: Malignant melanoma of the right maxillary alveolus in this 66–year-old man.
Figure 4: Malignant melanoma in the lower gingiva. Note the proliferative growth with blackish discolouration arising from the lower gingiva of the left central incisor to the second molar on the right side.
Figure 5: Malignant melanoma of the left buccal mucosa. Note the pigmented patch with nodular areas on the buccal mucosa of this 26–year-old man.
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