A Rare and Extensive Case of Oral Malignant Melanoma involving Mandibular Gingiva

Abstract

A 55-year-old male patient was referred to the Department of Oral Pathology, Manubhai Patel Dental College and Hospital and Oral Research Institute, Vadodara, Gujarat, India with a chief complaint of painless growth in the mandibular anterior gingival region since four months. Patient's medical and dental history was noncontributory. Intraoral examination showed an ovoid pigmented growth on the labial gingiva of mandibular anterior region, soft in consistency, grayish black in colour, measuring about 2.6 X 1.7 X 0.8cm. It was sessile, lobulated extending superiorly to the middle third of mandibular central incisors, inferiorly upto the labial vestibule, covering the labial mucosa and extending upto the buccal mucosa in right third molar region. The growth extended to the lingual aspect of mandibular anterior gingival region which was grayish black in colour, soft in consistency measuring about 4.1 X 1.7 X 1.2 cm extending from distal aspect of left mandibular lateral incisor to distal aspect of right lesion was seen covering the mandibular first premolar. The pigmented lesion was seen covering the mandibular marginal gingiva both buccally and lingually and buccal vestibule of the right side extending till the retromolar area [ H&E stained sections of incisional biopsy specimen showed nodular mass of malignant melanocytes invading into the connective tissue. The malignant cells were atypical, hyperchromatic, spindle shaped cells with vesicular, hyperchromatic nuclei and prominent nucleoli. Few mitotic figures were also seen. The cells contained fine melanin granules that appeared brownish in colour. These cells were distributed into sheets and groups in the juxta-epithelial region and mucosa. The overlying epithelium was stratified squamous and showed dysplastic features such as hyperchromatism and loss of polarity 7]. Immunohistochemical staining was performed to confirm the origin of the malignant cells. HMB 45, which is the preferred marker for melanocytes, was used and the cells showed high positivity for HMB 45 marker thus confirming diagnosis of melanoma [Table/ Fig-8].Based on the histopathological features and immunohistochemistry, a confirmatory diagnosis of invasive nodular malignant melanoma was given. DisCussionMelanoma constitutes only 3%-5 % of all cutaneous malignancies, and accounts for most skin cancer related deaths (77%) [1]. Oral melanoma is aggressive neoplasm which accounts for less than 0.5% of all melanomas commonly affecting palate and maxillary gingiva whereas mandible, tongue, buccal mucosa and upper and lower lip are less frequently affected [2,3]. Our patient is one of those rare case with the lesion occurring in the mandibular gingiva. It occurs in adults between 55 and 65 years of age and exhibits a male predilection. In our case also the age and gender of the patient was in accordance with the above mentioned findings [4]. Although there is no racial predilection, Afro-Americans and Asians are more commonly affected than Caucasians [5]. The aetiology of oral malignant melanoma is u...

Damakta ve gingivada malin melanom: Nadir bir lokalizasyon

“…Oral melanoma shows color variations that can range from black, brown, gray, purple, and can also show red tones or be depigmented. 8 In our case, asymptomatic swelling of grayish black color with a smooth and sessile surface and well-defined borders was detected. Differential diagnosis of melanoma are oral melanotic macula, cigarette-related melanosis, drug-related melanosis (antimalarial drugs and minocycline), melanoplakia, Cushing's syndrome, postinflammatory pigmentation, melanotic nevi, blue nevus, Addison's disease, Peutz-Jeghers syndrome, Kaposi's sarcoma.…”

Primary retromolar malignant melanoma in a Latin American patient

“…10 Our patient was treated in accordance with recommendations described in the literature: wide surgical excision was performed with ample margins and adjunctive radiotherapy; chemotherapy and immunotherapy were also recommended. 2,9,10 Oral mucosal melanoma is an aggressive disease with extremely poor outcome, but the 5-year overall survival rate is reportedly greater than 30%. [18][19][20] Prompt diagnosis and rapid treatment of oral malignant melanoma are essential for a good prognosis.…”

“…The melanoma becomes a strongly pigmented tumor, sometimes ulcerated and hemorrhagic, which tends to increase in size. 4,[7][8][9] The most commonly affected mucous membranes include the conjunctiva, upper respiratory tract, nasal cavity, paranasal sinuses, and oral cavity. Within the oral cavity, the most frequently affected sites include the palate and maxillary gingiva; combined, these sites exhibit 80% of all melanomas in the oral cavity.…”

Palatal Melanoma: ʺThe Silent Killerʺ

“…The main aetiology reason for the pathologic proliferation of malignant melanocytes along the junction between the epithelial and connective tissues is not established yet [ 3 ]. Although chronic irritation, tobacco, alcohol and formaldehyde exposure have been implicated as possible risk factors, it is considered that most of the melanomas of oral cavity arise de novo [ 4 ]. In contrast to cutaneous melanoma, no particular precursor lesion has been identified, and atypical melanocytic hyperplasia is considered as a proliferative phase [ 2 ].…”

“…Surgery is the first choice of treatment which often require subsequent reconstruction of the defects and advanced cases [ 3 ][ 4 ]. However, the 5 -year - survival rate in advanced cases with bone destruction varies between 5 - 20% and only 6.6% more than five years, which emphasise the underhanded aggressive nature of this kind of tumours [ 2 ][ 7 ][ 8 ].…”