Primary malignant melanoma of the oral cavity. Report of a case. Review of the literature

Malignant melanomas of the oral mucous membrane seems an infrequent pathology. They are characterized by a late diagnosis, bad prognosis and a disappointing treatment, because of the difficulties encountered for its total removal owing to complicated accessibility. We report one case of mucous membrane of the mouth in a 56 year-old man, diagnosed and operated in the General Hospital of Specialties "Ciudad de Jaen". The article end with a careful revision of the literature.     

Primary malignant melanoma of the larynx

Primary malignant melanoma of the larynx is very rare. The case of larynx malignant melanoma in 71-years old men is presented. Hoarseness was the main complaint that encouraged the patient to visit a doctor. The patient was heavy smoker, he had been smoking 40 cigarettes for the last 50 years. He used to drink about 200 ml of pure alcohol per day. In the direct laryngoscopy gluish had cyanotic tumor, extending to the true vocal cord, ventricle, ventricle fold and subglottic space was seen. Enlarged cervical lymph nodes, laterally to the main vessels were found both in palpation and in US examination. Total laryngectomy and neck dissection was performed. The histological examination of surgical specimen revealed; Malignant melanoma. Metastases in the lymph nodes. Neoplastic infiltration of the nodal capsule. The patient was admitted to the complementary radiotherapy. At the moment the follow up in outpatient. The article contains the review of literature concerning the diagnosis, treatment and prognosis in cases of laryngeal malignant melanoma.     

Primary malignant melanoma of the pharynx.

Primary mucosal malignant melanomas are rare. They appear late in life and their prognosis is grave. Although there is no consensus on therapy, wide surgical resection followed by radiotherapy, chemotherapy and immunotherapy are treatment modalities. In this report we present a case of widespread primary mucosal malignant melanoma located in the pharynx. After immunotherapy (four cycles of interleukin-2 and interferon-alpha) and chemotherapy (four cycles of cisplatin and dacarbazine) has been applied as primary therapy for suppression of the mass, transoral total pharyngeal resection was performed. After surgery three cycles of immunotherapy and three cycles of chemotherapy were administered followed by radiotherapy (total dose of 6600 cGy). An additional three cycles of immunotherapy and chemotherapy were administered. Although no local recurrence was observed during the 14 months of follow-up after the completion of radiotherapy, cranial and lung metastasis were detected in the 12th month.     

Endoscopic removal of malignant melanoma of the nasal cavity

Mucosal melanoma of the nasal cavity is a rare tumour. With the extended used of nasal endoscopes and advent of CT scan, early diagnosis of nasal melanoma and accurate assessment of its extent is possible. This allows endoscopic excision of tumour, avoiding unnecessary removal of healthy tissue. Here we present a case where endonasal endoscopic excision with postoperative radiotherapy achieved disease free survival till follow up (nearly 2 years).     

Early radiation-induced malignant fibrous histiocytoma of the oral cavity

With an incidence of less than 0.3 per cent, post-radiation sarcomas are rare malignant neoplasms with a very poor prognosis. On average, they occur after a latency period of at least 15 years following radiation therapy with doses ranging from 24 to 80 Gy. We present the case of a post-irradiation malignant fibrous histiocytoma (MFH) on the floor of the mouth in a 79-year-old male patient arising only five and a half years after radiation therapy. The primary tumour was classified as a well differentiated squamous cell carcinoma of the right rim of the tongue. Primary therapy was surgical resection of the tumour and post-operative radiation with 50 Gy. Five and a half years later, the patient developed a rapidly progressing MFH within the field of radiation.     

喉腔及喉咽部原发性恶性黑色素瘤——4例报告并文献复习

喉腔及喉咽部原发性恶性黑色素瘤极为罕见。1985年～1997年8月,共收治喉腔、喉咽部粘膜原发性恶性黑色素瘤各2例,肿瘤多伴有溃疡并缺乏色素,临床表现为声音嘶哑、吞咽困难、咯血、咽部不适等,易与该部位常见的鳞状细胞癌相混淆。其中完整详实的病史、全面彻底的体格检查可提供重要的诊断依据,免疫组化病理有助确诊。大范围彻底的手术切除、根治性颈淋巴结清扫术可作为局限性原发病变的首选治疗。对术后可疑残留病变,可辅以放疗或化疗。     

Primary mucosal malignant melanoma of the middle ear.

Only one case of primary malignant melanoma of the middle ear has been reported in the literature to date. We report a case of middle ear and nasopharyngeal malignant melanoma where the primary is likely to have arisen in the middle ear and discuss the relevant literature.     

Primary malignant mucosal melanoma of the head and neck

PURPOSE OF REVIEW: Primary malignant melanoma of the head and neck is an uncommon disease associated with a very poor prognosis, and an unpredictable natural disease process. Most patients, when diagnosed, pose a major dilemma to their treating clinicians as to what is the most appropriate current management options available with their likely short-term or long-term results. RECENT FINDINGS: Not much new has been reported in terms of aetiology and biology. There have been proposals for improvements in staging disease at presentation, so as to permit better analysis of results. Surgery continues to be advocated as the treatment option of choice. The role of radiotherapy as primary management of mucosal malignant melanoma remains controversial, but its use following surgery does seem to achieve local tumour control and patient survival. The use of chemotherapy or immunotherapy in mucosal malignant melanoma continues to lack structure and a role. Patients presenting with mucosal malignant melanoma should be registered and entered into a national or even international randomized controlled trial, which includes surgery, radiotherapy and immunotherapy. SUMMARY: Primary malignant mucosal melanoma of the head and neck is rare. The current standard of treatment remains surgery with postoperative radiotherapy. Such treatment aims at local disease control, with close follow-up observation and salvage treatment for local, regional and disseminated disease if it occurs. Salvage treatments are rare and uncommon, and most do not result in any significant additional patient survival. The role of chemotherapy and immunotherapy remains speculative unless patients are entered into some form of randomized controlled trials.     

Primary malignant melanoma of the nose and paranasal sinuses

Primary mulignant melanomas are rare tumours in the head and neck. The pigmentation of ths mucous membrane with or without the pigmentation of skin around it should raise the suspicion and should be confirmed by pathologist from a fresh biopsy specimen Radical surgery is the preferred treatment followed by radiotherapy in case of doubt regarding radicality of the surgical procedure. Six cases of malignant melanoma of nose and paranasal sinuses who reported within fourteen months are presented. This paper was presented in 43rd Annual conference of AOI at Jaipur.     

Autologous tumor-specific immunotherapy for recurrent malignant melanoma of the nasal cavity

Malignant melanoma usually occurs in tissues containing large numbers of melanocytes, such as the skin, mucosa and eye, and is one of the most highly malignant tumors known. No satisfactory treatment results have ever been reported. We report here an effective course of immunotherapy consisting of the local injection and intra-venous administration of autologous tumor-cell-stimulated cytotoxic T lymphocytes in a patient with recurrent malignant melanoma. The patient was a 45-year-old woman. She had been diagnosed as having malignant melanoma in 1996 and under went radio-chemotherapy at our hospital. Seven years later, recurrences were recognized in bilateral nasal cavities. Following systematic chemotherapy, 23 local injections of cytotoxic T lymphocytes were performed. Mediastinal lymphonode metastasis was recognized in March, 2004, so 15 additional intravenous administrations of cytotoxic T lymphocytes were performed. At present, no obvious regrowth has been recognized. Immunotherapy using cytotoxic T lymphocytes may be a useful strategy for controlling recurrent malignant melanoma.     

Malignant melanoma of the oral cavity: Review of 10 cases

Oral malignant melanoma is uncommon, comprising less than 1% of all malignant melanomas. Consequently, few cases have been reported from any one institution. We report 10 cases of malignant melanoma of the oral cavity seen at the Mayo Clinic between 1905 and 1979.     

Primary malignant melanoma arising from the base of the tongue

A rare case of malignant melanoma of the base of the tongue in a 65-year-old Japanese woman is described. The primary and metastatic tumors were treated by surgery, chemohormone and immunotherapy. There was no recurrence for 5 years after the initial diagnosis. Electron microscopy suggested that the melanosomes of the melanoma cells in the cervical lymph nodes were less mature than those in the primary melanoma cells; melanosome immaturity was consistent with a more aggressive quality.     

Malignant melanoma of the upper respiratory tract and the oral cavity.

Twenty-six patients with mucosal malignant melanoma of the upper respiratory tract and of the oral cavity were seen at the oncologic departments of eastern Denmark from 1955 to 1989. There were 17 males and nine females with an average age of 65 years. Primary symptoms lasted from one to 24 months and depended on localization of tumor. Five patients had lymph node metastases at the time of diagnosis; one also had distant metastases. Ten patients had surgery as primary treatment, 10 had combined surgery and radiotherapy and six had radiotherapy. Complete remission after primary treatment was seen in 22 cases (85%) and lasted from three to 94 months. Seventeen patients had recurrence, six of these had recurrence twice or three times. The five-year crude survival was 35% and only one patient (4%) lived more than 10 years. Recurrence-free survival among the 22 patients with initially complete response was 14%.     

Primary malignant melanoma of the epiglottis: a rare presentation

Primary malignant melanoma of the epiglottis is extremely rare. Until now, only 4 cases have been reported in the world literature. We describe a new case of epiglottic primary malignant melanoma in a 74-year-old man who presented with hoarseness and a foreign-body sensation. Clinical examination revealed the presence of a small, whitish, polypoid tumor on the laryngeal surface of the epiglottis; no other primary melanoma was detected. Wide excision of the lesion was performed, and microscopy revealed that it contained melanin-pigmented tumor cells in both the mucosa and submucosa. Immunostaining was positive for S-100 protein. The patient was treated with radiotherapy, and he remained well 1 year after the diagnosis with no evidence of recurrence.