MELANOMA IV: unusual presentations
Introduction Head and neck melanoma is a rare and aggressive neoplasm of melanocytic origin that accounts for 8–15% of all head and neck malignancies, including cutaneous melanomas. In oral cavity, more often it is found in areas where mucosa covers bone surfaces, such as hard palate and alveolar crest. This location plays a significant role to the early invasion of the underlying bone, constituting an additional factor of poor prognosis. The etiology and pathogenesis are still obscure. Treatment remains a challenge. Surgery has traditionally been the main therapeutic approach. The role of postoperative radiotherapy has never been clearly established.
Methods From February 2008 to July 2009, four patients with pigmented lesions of the oral cavity presented to our department. The clinical and histological examination confirmed primary melanoma. Treatment modality decided by the multidisciplinary oncology team.
Results Sites of melanoma localised on hard palate (three cases) and alveolar crest of the mandible (one case). Three patients were classified as stage I and one as stage III. The two patients with stage I disease had surgery alone. The third patient with stage I disease had surgery followed by immunotherapy. The stage III patient had chemotherapy alone. Diagnostic procedure, surgical treatment and outcome will be discussed in details for each case.
Conclusion The present report confirms a poor prognosis for patients affected by primary melanoma in oral cavity, independently from the treatment modality, being surgery alone or surgery followed by radiotherapy and/or chemotherapy.