Primary malignant melanoma of oral cavity.

Abstract

Primary oral malignant melanomas (POMM) are very rare. Definitive identification is usually possible only after they develop metastases. So every new case is instructive. P.P., a 76-year-old woman presented with a painless exophytic mass (measuring 3 x 3.5 cm) on a pedicle in the right alveolar crest of the upper jaw (teeth 6, 7 and 8) and the palate. The mass was dark red with lobate and ulcerated surface and dense and elastic consistency. Electroresection was performed until healthy tissue was reached. One year later there were enlarged lymph nodes submandibularly on the right: a metastasis arising from an achromatic melanoma of the upper jaw. Fontana-Masson staining, expression of S-100 protein in the melanocytes. The patient was in good condition two years after the administered telegamma and immunotherapy. POMM affects mainly men at advanced age. It is four times as frequent in the upper jaw and palate as it is on the surfaces. The tongue is not affected by POMM but is targeted by the melanoma metastases. Only one third of all cases of POMM are pigmented. They arise on the basis of premelanotic changes. Every equivocal pigmented lesion in the oral cavity should be obligatorily subjected to biopsy. Primary lymph dissection is not used routinely. The therapy of choice is a radical resection combined with chemical, radio and immunotherapy. Prognosis remains grave in spite of treatment.