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Mucosal melanoma  

fucosal melanomas of the oral cavity are rare, representing about 0.5% of oral malignancies . They arise in middle-aged adults, with a male predominance . These tumours are more common in dark-skinned races and in Japanese . No etiological factors have been identified. These tumours arise more commonly on the palate and maxillary gingivae . 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:

• Haemangioma
• Melanotic macule
• Oral mucosal nevi
• Amalgam tattoo
• Kaposi sarcoma

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 . 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% .

Image	Caption
	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.