Primary Malignant Melanoma of the Maxillary Gingiva

BACKGROUND: Mucosal malignant melanoma arising from the mucosa of the head and neck region is a rare entity, accounting for approximately 0.2% of all melanomas. Most of these lesions (80%) have occurred on the maxillary anterior gingival area, especially on the palatal and alveolar mucosa. OBJECTIVE: Mucosal malignant melanomas are more aggressive than cutaneous melanomas. On the other hand, complex anatomy of this area makes complete surgical excision difficult. Thus, early diagnosis and treatment are important. METHODS: We presented primary malignant melanoma of the maxillary gingiva in two cases. CONCLUSION: In mucosal malignant melanoma, survival rates may be increased by early diagnosis and treatment. The clinician must carefully examine oral cavity, and pigmented lesions should be biopsied. Because some melanomas may be amelanotic, a high index of suspicion is necessary.     

Primary Malignant Melanoma of Maxillary Gingiva

Malignant melanoma of maxillary gingiva is a rare clinical entity. Mucosal melanoma is more aggressive than cutaneous form and carries comparatively poorer prognosis. High index of suspicion is required for diagnosing malignant melanoma of oral cavity. Any pigmented lesion in the oral cavity should be taken seriously by the clinician.     

Malignant melanoma in the palate of a 3-month-old child.

BACKGROUND: Malignant mucosal melanoma of the head and neck is a rare cancer in adults that carries a grave prognosis. Three mucosal melanomas in pediatric patients have previously been reported. METHODS: We present here the youngest case of malignant mucosal melanoma of the head and neck in a 3-month-old boy. He presented with a 2 x 2-mm-pigmented lesion on the anterior maxillary alveolus. The patient was treated with local excision alone. RESULTS: The patient has remained disease free with regular follow-up for 117 months. CONCLUSION: Based upon this case and the few cases reported in the literature, mucosal melanoma is a much less common disease in children than in adults. Further, juvenile mucosal melanoma displays a benign clinical behavior.     

Primary malignant melanoma of the oral cavity. A review of 20 cases

Twenty patients with primary malignant melanoma of the oral cavity have been described. They formed 3.9 percent of the total number of patients with malignant neoplasms of the oral cavity. The upper gingiva was most commonly affected. In this series, there were 14 male patients and 6 female patients who ranged in age from 26 to 80 years (average 58 years). The first symptom of melanoma was hyperpigmentation of the mucosa in 10 patients, tumor in 7, and pain in 3 edentulous patients with prostheses. Radical surgery was performed in 13 patients, followed by chemotherapy and radiotherapy in 9 cases. Only 1 patient survived 9 years. The remaining 12 died 11 to 18 months after radical treatment. Palliative therapy was applied in three patients, two patients were treated symptomatically, and two patients refused treatment. Early detection of melanoma is an indication for radical treatment and may increase the survival rate of patients with this disease, which is still very low.     

Mucosal malignant melanoma in upper aerodigestive tract: report of two cases

Primary malignant melanoma has been seen in virtually all sites and organ systems where neural crest cells migrate. Upper aero-digestive tract is the unusual site. We presented two cases of mucosal malignant melanoma. A 59-year-old female patient had been suffering from nasal airway obstruction and headache for three months, and was admitted to our clinic. There was an upper cervical lymphadenopathy 5 cm in diameter ipsilaterally. Computerized tomography presented a nasal mass originating from the left maxillary sinus, and extending into nasal cavity and the left lateral wall of nasopharynx. Left total maxillectomy and radical neck dissection was performed. Postoperative radiotherapy was applied. A 68-year-old male patient suffering from nasal airway obstruction, hypernasality, dysphagia, and oral bleeding was admitted to our clinic. Oral examination revealed the tumoral mass protruding downward through oropharynx. The second patient referred to medical oncology. There was no recurrence in the first patient 18 months later. And the second patient died one year later. We believe that nasal mucosal malignant melanoma was rare, and carefully evaluated since it may be amelanotic lesion. Nasopharyngeal mucosal malignant melanoma is very rare, and has worse prognosis.     

Oral malignant melanoma detected after resection of amelanotic pulmonary metastasis

INTRODUCTIONSolitary pulmonary metastasis from oral malignant melanoma is very rare.PRESENTATION OF CASEWe demonstrated a 84-year-old patient with a lung nodule that was diagnosed as malignant melanoma by video-assisted thoracoscopic resection. Because primary pulmonary malignant melanoma was extremely rare, the tumor was thought to be a metastasized from an occult primary lesion. A detailed physical examination revealed a black tumor in the oral cavity, and this was suspected to have been the primary. Resection of the hard palate tumor and dissection of the cervical lymph nodes were performed. The patient was simply followed up without further therapy at his request, and he died one year after surgery due to bleeding from a pleural metastasis of malignant melanoma.DISCUSSIONPrimary melanoma of the oral cavity is rare, accounts for 0.5% of all oral cancers, and 0.8–1.8% of all melanomas. Because of absence of symptoms in the early stage of the disease and the presence of the tumor in relatively obscure areas of the oral cavity, the diagnosis is unfortunately often delayed. In view of the rarity of primary lung melanoma, when lung tumor was diagnosed as malignant melanoma, detailed physical examination of the entire skin and mucosa including the oral cavity was necessary.CONCLUSIONOral malignant melanoma was very rare, but oral cavity should be examined when the pulmonary nodule was diagnosed as malignant melanoma.     

Acute Myeloid Leukaemia Diagnosed by Intra-Oral Myeloid Sarcoma. A Case Report

Myeloid sarcoma (MS) is a rare extramedullary malignant tumor composed of immature myeloid cells. It is strongly associated with a well known or covert acute myeloid leukaemia, chronic myeloproliferative diseases or myelodysplastic syndromes. Intraoral MS scarcely occurs. An unusual case of acute myeloid leukaemia, which was diagnosed by mandibular MS that was developed in the alveolar socket after a dental extraction, is reported. The histological examination (including immunohistochemical analysis) of a subsequent biopsy showed infiltration of the oral mucosa by neoplastic cells. This lesion was therefore classified as acute myeloid leukaemia. The patient was referred to oncologists that confirmed the initial diagnosis. The patient underwent chemotherapy and the mandibular tumor disappeared. Forty days later, a relapse of the disease, which appeared as a great-ulcerated lesion, was developed in the hard palate. Thirty days after the second chemotherapy had finished, a new intraoral tumor was developed in the vestibular maxillary gingiva. Review of the literature shows no report of intraoral relapse and particularly multiple relapse of a MS that involves the oral cavity. Even though MS is encountered infrequently in the oral cavity, it should be considered in the differential diagnosis of conditions (especially tumors) with a similar clinical appearance.     

Malignant mucosal melanoma of paranasal sinuses: A case report

IntroductionMucosal melanoma of paranasal sinuses is a rare disease with a challenging treatment and a poor prognosis. In this paper, we reported the successful multimodality treatment of malignant mucosal melanoma of frontal sinus.Case presentationA 65-year-old female presented with a frequent nosebleed for one month before admission. Computed tomography and magnetic resonance imaging showed a mass in the right frontal and ethmoidal sinuses with adjacent bone erosion and right orbit invasion. Biopsy revealed malignant melanoma. No metastasis was found. The definitive diagnosis was malignant mucosal melanoma of paranasal sinuses AJCC stage IVb (T4bN0M0). We used right frontobasal craniotomy to resect tumor for local control of the disease. Immunohistochemical staining was Melan A(+), S100(+), and HMB45(+). A week postoperative, she received adjuvant radiotherapy and immunotherapy (pembrolizumab). For three months postoperative, the patient had no recurrence and metastasis, no headache and no new neurological deficits. She returned to her daily activities.Clinical discussionMucosal melanoma of paranasal sinuses is usually aggressive and diagnosed at an advanced stage. Management options are surgery, radiation therapy, chemotherapy, and immunotherapy. These options were performed on a case-by-case basis and depend on the extent and location of the tumor. Despite that, the prognosis remains very poor, with a high rate of local recurrences and distant metastases. Therefore, post-treatment lifetime and frequent follow-ups are highly recommended.ConclusionThe critical issues in management of mucosal melanoma are early diagnosis, multimodality treatment, and frequent follow-ups.     

Multiple Synchronous Anorectal Malignant Melanoma Coexisting with Adenocarcinoma of the Sigmoid Colon

Primary anorectal malignant melanoma is an exceptionally rare neoplasm associated with poor prognosis. Anorectal malignant melanoma has been very rarely described with coexisting primary tumors of the colorectum. A 56-year-old female patient was admitted with a history of rectal bleeding. She had experienced increasing constipation and a sense of obstruction in the rectum for 6 months. Flexible rectosigmoidoscopy showed a large, pedinculated polypoid lesion extending from the anal canal to the rectum. She underwent a transanal local excision and was diagnosed with a melanoma of the anorectum with positive margins. Therefore, a formal abdominoperineal resection was performed. In addition to multiple synchronous anorectal malignant melanoma, we incidentally found another primary tumor in the proximal surgical margin of the resected specimen. Histopathologically, the lesion was an intramucosal adenocarcinoma of the sigmoid colon. Postoperatively, the patient received adjuvant chemotherapy of six cycles duration. At present, the patient has completed 18 months of follow-up.     

Pigmentierte Läsionen der Mundschleimhaut

Primary malignant melanoma of the oral cavity is an exceedingly rare event. The most frequently affected sites are the palate and the gingiva of the maxilla. The lack of symptoms often causes diagnostic delay. We report on a 78-year-old man with a history of melanotic pigmentation on the hard palate for many years. Due to tumor growth an incisional biopsy was performed which yielded the diagnosis of mucosal melanoma arising in a preexisting blue nevus. Mucosal melanomas of the upper airway are not classified as other melanomas but with their own TNM classification due to their special behavior. Although the classification by Clark cannot be applied, thickness and size of the tumor are known prognostic indicators.     

Lack of Correlation Between Microvascular Density and Pathological Features and Outcomes in Sinonasal and Oral Mucosal Melanomas

Unlike its cutaneous counterpart, prognostic markers for primary mucosal malignant melanoma have not been well elucidated. It has been recently demonstrated that microvascular density (MVD) in cutaneous malignant melanoma has a significant negative correlation with survival; however, this has not been well-studied in mucosal malignant melanoma of the head and neck. This study explores the potential association between MVD, various histological parameters, and the outcome of a series of sinonasal and oral mucosal melanomas. Nineteen such cases were immunostained with CD31 and the MVD was calculated by using Bioquant Image Analysis Software (R and M Biometrics, Nashville, TN). These cases included 16 sinonasal and 3 oral cavity tumors. The 1, 2, 3, 4 and 5 years overall survival rates were 75, 57, 61, 46 and 46%, respectively. The MVD of the tumors ranged from 25.7 to 732 vessels/mm² (mean 142.8 vessels/mm²; median 84.7 vessels/mm²). There was no significant correlation between the MVD and the different clinicopathological features seen within the tumors. There was also no correlation between the MVD and relapse free and overall survival. The results of this study suggest that MVD does not correlate with outcome in mucosal melanoma of the head and neck as seen in cutaneous melanomas. Further larger studies are needed to identify predictive and prognostic markers in such melanomas.     

Malignant tumors of the hard palate: Report of 4 cases and review of the literature

IntroductionCancer of the hard palate is a fairly rare malignant tumor. Different histological types have been described in the hard palate, and that can affect its different structures.Diagnosis is based on biopsy with histological examination and possibly on immunohistochemical markers to confirm the diagnosis and exclude other diagnostic hypotheses.The aim of this study was to determine histopathologic, clinical and therapeutic characteristics of malignant tumors of the hard palate.Patients and methodsA retrospective review of 4 patients who underwent Surgical resection by trans oral approach was performed for different histological types of malignant tumors of the hard palate. These included squamous cell carcinoma (case1 and case 2), mucosal melanoma (case 3), and adenocarcinoma (case 4).ResultsThe T stage was analyzed for all cases. Two cases were classified as T2 stage with a tumor size between 2 and 4 cm and the two others, given the extension to the maxillary and nasal cavity were classified as T4a. Cervical lymph node metastasis was found in three patients.DiscussionSurgical resection is the treatment of choice for malignant tumors of the hard palate. There is a variety of surgical procedures that can be used via a trans oral approach. Reconstruction of palatal defects with a prosthesis is sufficient, whereas larger defects will require a local, regional or even microvascular free tissue flap. The differences between these surgical techniques are presented, and indications are discussed.ConclusionThe therapeutic management for malignant tumors of the hard palate is essentially surgical, with or without postoperative radiotherapy, discussed on a case-by-case basis. Survival rate depends on several factors, including early diagnosis, histological characteristic and appropriate management.     

Metastatic Adenocarcinoma of the Colon: Early Manifestation in Gingival Tissue

A case of gingival metastasis of adenocarcinoma of the colon is reported, the lesion being an early clinical indication of a primary malignant tumor. The diagnosis of metastatic lesion in the oral region is always challenging, both to clinician and to the pathologist, due to its rarity and complexity. In the present case, the clinical hypothesis was peripheral ossifying fibroma or pyogenic granuloma. Histologically, the biopsy tissue revealed a malignant neoplasm not connected to the mucosal surface. Immunohistochemically, the lesion was positive for 35ßH11 and cytokeratin 20 and focally positive for cytokeratin 7. Treatment involved excision of primary tumor and follow-up chemotherapy. The clinical, histological and immunohistochemical characteristics are discussed.     

四肢恶性黑色素瘤28例的治疗回顾分析

目的:讨论恶性黑色素瘤的治疗方法及预后。方法:回顾分析笔者科室2008年1月~2011年12月收治的28例四肢恶性黑色素瘤患者,其中男性13例,女性15例,年龄最大者68岁,年龄最小者25岁,平均年龄43岁,发生于上肢者10例,发生于下肢者18例。所有病例均经病理证实为恶性黑色素瘤。入院后未行手术治疗者先取活检,术中切口距病灶缘约1cm,病检结果证实为恶性黑色素瘤后即行扩大切除术。已行手术者行原切口缘扩大切除术,距原切口缘3~5cm,术后行放化疗。结果:28例患者术后切口均I期甲级愈合,术后随访2年,21例患者未出现病灶复发,生存质量良好。7例因肿瘤复发或转移死亡。结论:恶性黑色素瘤患者的治疗选择扩大切除,辅以术后放化疗是一种有效的方法。     

治疗方式对肛管直肠恶性黑色素瘤预后的影响

目的 探讨不同治疗方式对肛管直肠恶性黑色素瘤的预后影响.方法 回顾性分析1965-2007年收治的60例肛管直肠恶性黑色素瘤患者的临床资料,并对预后进行生存分析和COX风险因素分析.结果 60例患者中,肿瘤发生于直肠者50例,发生于肛管者10例.53例行手术切除治疗.对行单纯手术的23例患者和术后辅助化疗、放疗、生物治疗等综合治疗的30例患者的资料进行生存分析,总生存率差异无统计学意义(X2=0.078,P>0.05).53例手术病例中,37例行Miles术,16例行局部扩大切除术,两种术式生存分析差异无统计学意义(X2=1.464,P>0.05).风险因素分析结果提示,肿瘤浸润深度为危险因素,治疗方式为保护因素.结论 手术切除是肛管直肠恶性黑色素瘤的主要治疗手段,对肛管直肠恶性黑色素瘤病变局限者,应首选局部扩大切除术;病变深度和治疗方式是影响预后的风险因素.     

Malignant change in giant congenital nevocellular nevi: our experience

Summary We present our experience in the surgical management of giant congenital nevocellular nevi (GCNN's). From 1983 to 1992, 13 cases were treated of which 11 were children and 2 were adults. The size of the lesions ranged between 3 and 60% of the body surface. All these patients underwent excision and skin grafting. In 6 cases, skin expansion was used. The patients were seen subsequently every 6 months with a 12 months minimum follow-up. In 2 pediatric patients, malignant degeneration of the lesion occurred: in the first case, a highly invasive nodular melanoma, in the second case, a lesion corresponding to minimal deviation melanoma. Our personal experience has shifted our attitude to the treatment of GCNN to a more aggressive approach. Early and radical excision of all the lesion is currently our first priority; esthetic refinements by means of skin expansion or other techniques are now delayed to subsequent procedures.     

Carbon dioxide laser ablation as first-line management of in-transit cutaneous malignant melanoma metastases

Introduction  In-transit cutaneous malignant melanoma metastases remains a difficult and distressing disease. It is a sequela to the primary lesion represented by melanoma deposits between the site of excision and the draining lymph nodes. We present our experience of carbon dioxide ablation of in-transit cutaneous malignant melanoma metastases and discuss the role of laser ablation as first-line management of the disease. Method  Using a departmental database and case notes, all patients who had undergone carbon dioxide laser ablation for malignant melanoma metastases in the authors’ unit between December 1996 and December 2007 were reviewed. Results  The total number of lesions ablated was 559 in 16 patients on 91 separate occasions. The mean number of lesions ablated at each treatment was 6 (range 4–200) and the mean number of treatments per patient was 5.7 (range 1–14). All patients had undergone previous surgical procedures for disease control (total 28, range 1–4). Ten patients remained clinically disease-free at 1-year follow-up. Of these ten patients. six achieved remission with a median time from first ablation of 7.5 years (range 2–10 years). Conclusion  Carbon dioxide laser ablation should be offered as first-line treatment in the management of cutaneous malignant melanoma metastases. A subgroup of patients were clinically disease-free with no systemic progression, following treatment, the reasons for which have not yet been fully explained. Presented at the British Medical Laser Association (BMLA) Annual Meeting, Manchester, July 2007.     

Metastatic Papillary Thyroid Carcinoma to the Maxilla: Case Report and Literature Review

Metastatic tumors to the oral cavity are uncommon and a thyroid origin is considered exceedingly rare. A case of metastatic papillary thyroid carcinoma (PTC) presenting as a painful swelling in the right posterior maxilla of a 63-year-old male is reported here. The patient had been diagnosed with PTC 2 years ago and treated with thyroidectomy and radioactive iodine treatment. Radiographically, the metastatic lesion presented as a poorly-defined radiolucent lesion around an impacted maxillary third molar in the right maxilla. Histopathologic examination revealed features of PTC which was immunohistochemically positive for pancytokeratin, keratin 19 and thyroglobulin. Imaging studies revealed the presence of residual maxillary and neck disease as well as additional metastatic lesions in the sternum, ribs, and left tibia. A thorough review of the English language literature revealed only 36 previously published cases of thyroid cancer metastases to the oral cavity, the demographic and clinicopathologic features of which are summarized.     

Clinical and pathologic distinction between primary and metastatic mucosal melanoma of the head and neck

Metastatic mucosal melanoma is extremely rare. Only 0.6% to 9.3% of patients with cutaneous malignant melanoma will have metastases to the mucosa of the upper aerodigestive tract. The records of all patients with mucosal melanoma of the head and neck at the University of California, Los Angeles Medical Center during the past 30 years were reviewed. Patients with primary tumors were separated from those with metastatic involvement from a cutaneous primary site. These two groups were compared for differences in clinical symptoms, histopathologic findings, treatment, and survival characteristics. Frequent sites of metastatic involvement included the base of tongue and nasal cavity. These arose from a variety of cutaneous sites including the trunk and extremities and, in most instances, did not arise until 2 to 7 years after the initial cutaneous lesion. Most of those with metastases to the head and neck mucosa had disseminated disease. The histopathologic distinction between the two groups is described with photomicrographs. Junctional activity in the overlying or adjacent mucosa distinguishes primary mucosal melanoma from metastatic disease, in which the overlying mucosa is usually intact. This difference is useful in determining workup and treatment options. Aggressive surgical resection is suggested in treatment of primary melanomas, whereas surgery is at best palliative in those with metastatic disease. (OTOLARYNGOL HEAD NECK SURG 1995;112:700-6.)     

Malignant melanoma with evidence of maturation arising from a giant congenital nevocellular nevus.

The association between melanoma and giant congenital nevocellular nevus has been well documented, although controversy still exists regarding the precise incidence. The following patient report illustrates the excision of malignant melanoma arising from a giant congenital nevocellular nevus in a 4-month-old infant. The child had malignant melanoma with deep dermal involvement diagnosed by incisional biopsy with positive margins. She underwent subsequent en bloc resection of the original biopsy site and nevus. The reexcision specimen showed no evidence of malignancy. No adjuvant chemotherapy was used. The child is disease free at 5 years. It is possible that very young children (infants) with melanoma arising in a giant congenital nevocellular nevus may have a good prognosis.