Oral malignant melanoma: An aggressive clinical entity - Report of a rare case with review of literature
Melanoma is one of the most dreaded and aggressive neoplasms, being derived from epidermal melanocytes. The majority
of melanomas are seen to involve the skin, and primary mucosal melanomas account for less than 1% of all melanomas.
Oral malignant melanomas (OMM) are asymptomatic at the initial presentation, but later they become painful with
growth and expansion. In the late stages, the patient may present with ulceration, bleeding, tooth mobility, paresthesia,
ill‑fitting prosthesis, and delayed healing of the extraction sockets. Diagnosis is often delayed due to asymptomatic clinical
presentation, with silent progression of the lesion. OMM are associated with poor prognosis due to their invasive and
metastasizing tendencies. The condition has poor survival rates, and metastatic melanomas show even worse prognosis.
The 5‑year survival rate for OMM ranges 4.5–29%, with 18.5 months being the mean survival rate. The tumor is best
managed by wide surgical resection; however, consideration should also be made for adjunctive therapies such as
chemotherapy, immunotherapy, and radiotherapy. Recurrences may be seen even 10–15 years after the primary therapy.
This paper aims to present an interesting report of aggressive OMM in a 50‑year‑old male patient and emphasizes the role
of dental professionals in maintaining a high degree of vigilance for the pigmented lesions of the oral cavity. Pigmented
lesions of uncertain origin should be routinely biopsied to rule out malignancy. Early diagnosis of this dreadful entity
entails thorough history taking, physical examination, and radiographic features coupled with histopathology.
Key words: Melanocytes, oral malignant melanoma, pigmentary lesions
of melanomas are seen to involve the skin, and primary mucosal melanomas account for less than 1% of all melanomas.
Oral malignant melanomas (OMM) are asymptomatic at the initial presentation, but later they become painful with
growth and expansion. In the late stages, the patient may present with ulceration, bleeding, tooth mobility, paresthesia,
ill‑fitting prosthesis, and delayed healing of the extraction sockets. Diagnosis is often delayed due to asymptomatic clinical
presentation, with silent progression of the lesion. OMM are associated with poor prognosis due to their invasive and
metastasizing tendencies. The condition has poor survival rates, and metastatic melanomas show even worse prognosis.
The 5‑year survival rate for OMM ranges 4.5–29%, with 18.5 months being the mean survival rate. The tumor is best
managed by wide surgical resection; however, consideration should also be made for adjunctive therapies such as
chemotherapy, immunotherapy, and radiotherapy. Recurrences may be seen even 10–15 years after the primary therapy.
This paper aims to present an interesting report of aggressive OMM in a 50‑year‑old male patient and emphasizes the role
of dental professionals in maintaining a high degree of vigilance for the pigmented lesions of the oral cavity. Pigmented
lesions of uncertain origin should be routinely biopsied to rule out malignancy. Early diagnosis of this dreadful entity
entails thorough history taking, physical examination, and radiographic features coupled with histopathology.
Key words: Melanocytes, oral malignant melanoma, pigmentary lesions