Clinical investigation of amelanotic malignant melanoma in the oral region

doi:10.1016/j.joms.2004.01.017

Journal of Oral and Maxillofacial Surgery

Volume 62, Issue 8, August 2004, Pages 933-937

https://doi.org/10.1016/j.joms.2004.01.017 Get rights and content

Abstract

Purpose

Amelanotic oral malignant melanoma (AOMM) is a rare tumor that is difficult to diagnose. We studied the clinical and pathologic features of nine cases of this tumor to define diagnostic criteria and estimate prognoses for 2 different types of AOMM.

Patients and methods

Nine patients with 2 different types of primary AOMM were examined between 1970 and 2002. The histopathology of surgical specimens was studied, uncertain diagnoses were supported by immunohistochemical reactions, and electron microscopy and prognoses were reviewed retrospectively.

Results

AOMM without radial growth phase may be particularly difficult to diagnose correctly without immunohistochemical assistance. Tumors consisted of a mixture of polygonal and spindle cells in different ratios in tumors with and without radial growth phase. The life span ranged from 3 months to 6 years 3 months, and all 9 patients died of the tumor. In 7 of the 9 cases, distant metastases were found.

Conclusions

AOMM without radial growth phase may be misdiagnosed as epulis or squamous cell carcinoma. Questionable lesions, particularly maxillary and palatal lesions, must be biopsied for histopathologic and possibly immunohistochemical examinations followed by rapid treatment. The prognosis of AOMM was poor.

Section snippets

Patients and methods

Nine patients with primary AOMM were examined between 1970 and 2002 in the First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University or the Department of Oral Surgery, Sapporo Medical University School of Medicine. The mean age of the patients (4 males, 5 females) was 67. 0 years, ranging from 46 to 84 years. Seven tumors occurred in both maxillary gingiva and maxillary palate, and 1 each only in the maxillary gingiva or maxillary palate.

The

Nonpigmented nodular type aomm

Clinically, nonpigmented tumor without a radial growth phase was found. Four of the 5 cases with this type of tumor were initially misdiagnosed as epulis, squamous cell carcinoma, or benign tumor because of the absence of pigments and radial growth phase. Regional metastases were recognized in 3 cases; distant metastases resulting in death were found in 4 of the 5 cases.

The life span ranged from 3 months to 4 years 1 month (Table 1). Histopathologically, the resection margins of the specimens

Discussion

In contrast to skin melanomas, the etiologic factors of oral melanomas are not well established. The incidence of oral malignant melanoma ranges from 0.2% to 8.0% of all melanomas.8, 9 Moreover, because amelanotic malignant melanoma accounts for only 2.3% of all melanomas,10 this type of melanoma is extremely rare. Amelanotic malignant melanoma was defined as a tumor composed of nonpigmented melanocytes11; however, in another report, a tumor that lacks pigmentation clinically and has melanin

References (28)

J.P Shah et al.
Mucosal melanomas of the head and neck
Am J Surg
(1977)
N Tanaka et al.
Oral malignant melanoma in Japan
Oral Surg Oral Med Oral Pathol
(1994)
Y Ducic et al.
Amelanotic melanoma of the palateReport of case
J Oral Maxillofac Surg
(2001)
S.Y Kao et al.
Maxillary amelanotic melanomaA case report
J Oral Maxillofac Surg
(2001)
M.J Hicks et al.
Oral mucosal melanomaEpidemiology and pathology
Oral Oncol
(2000)
L.C Kelley et al.
Immunohistochemical staining of lentigo maligna during Mohs micrographic surgery using MART-A
J Am Acad Dermatol
(2002)
N.S Peckitt et al.
Malignant melanoma of the oral cavityA case report
Oral Surg Oral Med Oral Pathol
(1990)
F.H Rampen et al.
Biopsy and survival of malignant melanoma
J Am Acad Dermatol
(1985)
T.V McCaffery et al.
Malignant melanoma of the oral cavity of 10 cases
Laryngoscope
(1980)
N Tanaka et al.
Malignant melanoma in the oral regionUltrastructural and immunohistochemical studies
Med Electron Microsc
(2001)

A.G Huvos et al.

A clinicopathologic study of amelanotic melanoma

Surg Gynecol Obstet

(1972)

E.S Moore et al.

Melanoma of the upper respiratory tract and oral cavity

Cancer

(1995)

M.E Pilskin

Malignant melanoma of the oral cavity

I.M Ariel

Amelanotic melanomasAn analysis of 77 patients

Curr Surg

(1981)

Cited by (43)

Clear cell oral squamous cell carcinoma as a diagnostic conundrum: report of 2 rare cases
2024, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
The occurrence of clear cell histologic sub-type of oral squamous cell carcinoma in the oral cavity is a distinct and exceedingly rare entity exhibiting aggressive behavior. To date, only 10 cases have been published in the literature. We describe 2 extremely rare cases, both presenting with swelling and ulcerated nodule-like proliferative growth in the mandible. Microscopically, sheets and lobules of neoplastic squamous epithelial cells showing clear cell differentiation were appreciated in both patients. Periodic acid-Schiff and mucicarmine revealed negative staining. Immunohistochemical (IHC) analysis for antibody for renal cell tumor marker CD 10 was immune-negative. The malignant clear cells in both cases showed intense positive reactions with IHC markers pan-cytokeratin and epithelial membrane antigen, confirming the diagnosis as a clear cell variant of oral squamous cell carcinoma (CCOSCC). The first patient was unwilling for treatment and eventually died within 2 months of the diagnosis. In the second patient, right hemi-mandibulectomy with level 1A and 1B lymph nodes was performed. Adjuvant chemotherapy with low-dose methotrexate was initiated. Follow-up after 2 months of surgery was uneventful. Current rare reports emphasize the significance of prompt and extensive diagnostic work-up of clear cell neoplasms, as the CCOSCC may be fatal.
Pigmented Lesions
2020, Dermatologic Clinics
Citation Excerpt :
Clinical: clinically, most oral mucosal melanomas are diagnosed as pigmented nodular lesions (Fig. 5). A classification of the 5 varied presentations of oral mucosal melanoma has been proposed: (1) pigmented nodular, (2) nonpigmented nodular, (3) pigmented macular, (4) pigmented mixed, and (5) nonpigmented mixed.39 The most common sites are the hard palate and gingiva.38
Lesions of the Oral Cavity
2020, Gnepp's Diagnostic Surgical Pathology of the Head and Neck, Third Edition
Mucosal melanoma of the head and neck
2017, Critical Reviews in Oncology/Hematology
Citation Excerpt :
Oral MM generally presents as a hyperpigmented lesion, with a wide range of colours varying from black, brown, grey to reddish or white (Penel et al., 2006). Interestingly, oral lesions may be amelanotic in up to 10–30% of cases; in these patients, diagnosis may be challenging (Tomicic and Wanebo, 2003; Tanaka et al., 2004; Sun et al., 2012). Oral MM may have either a nodular or macular appearance (Tanaka et al., 1994; Wu et al., 2014).
Mucosal melanoma of the head and neck is a very rare and aggressive malignancy with a very poor prognosis. The nasal cavity, paranasal sinuses, and oral cavity are the most common locations.
One-, 3- and 5-year survival rates between 2000 and 2007 were 63%, 30% and 20%, respectively. Cigarette smoking seems to be a risk factor even though the evidence for this is very low. Clinical signs and symptoms are usually nonspecific. While surgery is considered the mainstay of treatment for most mucosal melanomas of the head and neck region, radiotherapy has a role in local control of the disease after surgery. Many new treatment options in the last years, in particular targeted therapies (i.e. inhibitors of c-KIT, NRAS/MEK or BRAF) and immunotherapies (anti CTLA-4 and anti PD-1/PD-L1 antibodies), have changed the history of cutaneous melanoma. Despite the different biology, mucosal melanoma is currently treated in the same way as cutaneous melanoma; however, patients with mucosal melanoma were excluded from the majority of recent clinical trials. Recent molecular findings offer new hope for the development of more effective systemic therapy.
Oral malignant melanoma: Systematic review of literature and report of two cases
2013, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
Umeda et al. noted that on close examination typical OMM usually presents with 3 distinct components: a nodular component usually affecting the center; a flat or slightly elevated, deep brownish-black pigmented plaque component; and a nonelevated light brown macular component.16 Approximately 10% of cases are known to be amelanotic in nature, lacking macular component, thus posing a difficulty in diagnosis.17 Induration is usually absent in cases with prolonged radial growth phase or with minimal invasion.
Oral malignant melanoma (OMM) is a rare tumor of the oral cavity with very poor prognosis despite the implementation of an aggressive treatment. This paper aims to shed some light on current evidence for management of OMM.
We report 2 cases of OMM treated at our institute and a review of the literature in an endeavor to establish current understanding on various aspects of OMM.
Both patients in our study are showing good local control with aggressive multimodal treatment. Long-term follow-up is needed to rule out distant metastasis.
Because late diagnosis and advanced disease at the time of diagnosis are the only sure predictors of outcome, thorough clinical and pathologic workup of any suspected melanotic lesion should be carried out to diagnose OMM. Early diagnosis and aggressive multimodal treatment are the only means available to surgeons to provide better outcome to patients with OMM.
Amelanotic melanoma of the mandible: A case report
2011, Oral Science International
Amelanotic melanoma of the oral mucosa is extremely rare. We describe herein our experience of amelanotic melanoma arising in the mandibular mucosa. An 85-year-old woman was referred to our clinic with swelling of the left lower gingival mucosa. The histopathological diagnosis was amelanotic melanoma, as determined by immunohistochemical examination. The tumor cells were positive for S-100, Melan-A, HMB-45, and vimentin. The patient declined surgical treatment, so she received irradiation therapy. At a total dose of 10 Gy, the patient exhibited lassitude, so we terminated radiotherapy. Bleeding from the tumor persisted, and the patient developed anemia and hypouresis. She also contracted pneumonia. The patient's general condition worsened, and she died.

View all citing articles on Scopus

View full text

Clinical articlesClinical investigation of amelanotic malignant melanoma in the oral region

Abstract

Purpose

Patients and methods

Results

Conclusions

Section snippets

Patients and methods

Nonpigmented nodular type aomm

Discussion

Am J Surg

Oral Surg Oral Med Oral Pathol

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Oral Oncol

J Am Acad Dermatol

Oral Surg Oral Med Oral Pathol

J Am Acad Dermatol

Malignant melanoma of the oral cavity of 10 cases

Laryngoscope

Malignant melanoma in the oral regionUltrastructural and immunohistochemical studies

Med Electron Microsc

A clinicopathologic study of amelanotic melanoma

Surg Gynecol Obstet

Melanoma of the upper respiratory tract and oral cavity

Cancer

Malignant melanoma of the oral cavity

Amelanotic melanomasAn analysis of 77 patients

Curr Surg

Clinical articles
Clinical investigation of amelanotic malignant melanoma in the oral region