A primary oral mucosal melanoma: a 20-year follow-up case report

• Published in: Annali di stomatologia Vol. 8; pp. 70 - 71
• Main Authors: Nori, A, Zavaglia, V, Rubini, C, Tesei, A, Mascitt, M
• Format: Journal Article
• Language: English
• Published: Rome CIC Edizioni Internazionali 01.01.2017
• Subjects: Anesthesia; Biocompatibility; Biomedical materials; Biopsy; Bleeding; Case reports; Cheek; Chorion; Cleft lip/palate; Histopathology; Immunotherapy; Infestation; Lesions; Lymph nodes; Medical prognosis; Melanoma; Metastases; Motivation; Mucosa; Oral cancer; Oral hygiene; Osteotomy; Outbreaks; Pain; Patients; Radiation therapy; Survival; Tumors
• ISSN: 1824-0852; 1971-1441

Oral mucosal melanoma (OMM) is rare tumor (0.5% of all oral malignancies) with a poor prognosis. OMM affects between fifth and seventh decade of life with a slighter prevalence of male. In the 80% of cases OMM affect hard palate and the maxillary gingiva. Risks factor are unknown, although several studies describe a higher incidence of OMM in smokers. Early lesions have variable size and different pigmentations resuming in ABODE rule. Diagnosis of OMM is often delayed because of its hidden location and the lack of early symptoms until dental mobility, bleeding sensations, growing and expansion occurs. At the time of 25% of patients had regional lymph node metastases and 10% had distant dissemination. 18.5 months is the mean survival period with a 5-year survival rate of 4.5-29%. Surgical resection, radiotherapy and immunotherapy are the main treatment protocols, with a recurrence rate of about 50%. The aim of this study is to describe a case with a 20-year follow-up. A 74-year-old male patient was reported in May 1997 with a compliant of worsening pain and swelling from hard palate. The patient was hard smoker, with poor oral hygiene. Past medical history was unremarkable. Extraoral examination were negative, while intraoral examination showed a wide dark coloured lesion affecting the right hard palate from premaxilla to 5 cm posterior and from palatine raphe to 3 cm lateral to right alveolar crest. The neoplasm was nontender, firm in consistency, measuring 4.5 x 3 cm. ABODE rule was clearly positive and a was staged T4N0M0 after a negative total body PET-TO. An en block resection of the neoplasm was conducted. Under general anesthesia the cleavage plate and the bo- ne plate were exposed and osteotomy was performed using a bone burst. Surgical wound was sutured and topical agents supporting secondary intention healing were used. Histopathology showed intraepidermal melanoma outbreaks and infestation of the chorion with discrete peritumoral lymphoplasmic cell infiltrate. Patient attended a regular follow-up but in November 1998 an OMM in situ of 1 x 0.5 cm was resected. Also in July 2004 and October 2005 several excisional biopsies were performed revealing Outbreaks of in situ OMM. Two other lesions were resected from right hard palate and upper lip revealing ulcerated OMM in May and September 2006. Deep cervical lymph nodes were metastatic. In May 2017, the patient was referred again for an ulcerated exophytic lesion of about 2 cm on the right cheek and 0.5 cm one on the right half of the oral floor. After excisional biopsy histopathology showed another OMM. Considering the peculiarity of the patient's condition, the decision to start a palliative therapy was taken.