A case of oral mucosal melanoma. Clinical and dermoscopic correlation.

Abstract

Background: Most patients with oral mucosal melanoma have had a mucosal hyper pigmented area for months or even years before the diagnosis, it is important to consider the differential diagnosis of mucosal melanoma, which in many cases is a difficult diagnosis and because of the aggressive biological behavior of mucosal melanoma it is important to do a quick diagnosis. Main observation:A 40-year-old Mexican male patient, presented with a lesion on the lower right half of the lip covering almost the entire vermillion border, 1 mm below the white roll. The lesion was a 1.5 x 4 cm pigmented macule with asymmetric and irregular borders and colors. Dermoscopy showed a multi component pattern. An incision biopsy was performed under the impression of mucosal melanoma. The pathologic report described a Clark I vermillion edge mucosal melanoma in situ. Conclusions:This case had confounding clinical signs that could have misguided the clinician. But dermoscopy proved to be useful when suspecting a malignant lesion, which prompted a biopsy and a correct diagnosis. (J Dermatol Case Rep. 2012; 6(1): 1-4) A case of oral mucosal melanoma. Clinical and dermoscopic correlation.Tamar Hajar-Serviansky, Daniela Gutierrez-Mendoza, Iris L. Galvan, Lorena Lammoglia-Ordiales, Adalberto Mosqueda-Taylor, Maria de Lourdes Hernandez-Cázares, Sonia Toussaint-Caire Dermatology Division, Hospital General "Dr. Manuel Gea González", Mexico City, Mexico. IntroductionThere are many lesions that present with an increase in oral mucosal pigmentation, with an intrinsic and extrinsic origin. Since most patients with oral mucosal melanoma have had a mucosal hyper pigmented area for months or even years before the diagnosis, it is important to consider the differential diagnosis of mucosal melanoma. Case ReportA 40-year-old Mexican male patient, Fitzpatrick's skin type III, presented with a lesion on the lower right half of the lip covering almost the entire vermillion border, 1 mm below the white roll. The lesion was a 1.5 x 4 cm pigmented macule with asymmetric and irregular borders and colors. The white roll had an infiltrated area that was slightly elevated and deformed with grouped vesicles and erythema (Fig. 1).According to the patient, the lesion had always been present, and was confident the elevation and erythema were in the hard palate and upper alveolar ridge. Jaw, retromolar, trigone, and floor of the mouth were involved in 3 cases (8.57%); 3 melanomas (8.57%) were detected in the labial mucosa and 2 (5.71%) on buccal/vestibular mucosa. Only 1 case (2.86%) was diagnosed on the lateral border of tongue, and in 1 case (2.86%), they could not identify the site of the lesion. 7The biological behavior of mucosal melanoma notoriously differs from the one shown in case of skin melanomas. Likely reasons are late diagnosis and treatment; anatomic differences in location, a greater blood and lymphatic flow in mucosa, easing its spread and differences in its genetic profile. For the above, in general, it has a bad prognosis with a 5-ye...

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