Oral Melanoma Etiology: Malignant oral melanomas of the head and neck region are rare and account for 0.2 to 0.5% of all melanomas in the United States (Regezi et al., 2003). The cutaneous melanoma rate is more pronounced in certain areas of the world where the sun is more intense and children are exposed to intense sunlight. Oral melanoma occurs in the oral tissues that are not exposed to the sun, and the etiology is very different for oral melanomas and not as clearly understood. Although the etiology of the oral melanoma is unknown, tobacco use (Meleti, 2006), chronic irritation, formaldehyde exposure, familial history, and cytogenetic defects may play some role in its development. Method of Transmission: Not applicableCharacteristics: The most commonly affected sites are the hard palate and maxillary gingiva. The melanoma is usually a brown, red, black, and even black-bluish color and may be slightly raised, with irregular borders. The lesions may have a rapid growth pattern, with a deep invasive nature. Melanomas may appear exophytic or ulcerative, and the colors may be mixed, depending upon the stage of the neoplasm. Asymmetry and irregular borders are key signs related to melanomas. Enlarging masses, whether pigmented or amelanotic (those that are more flesh colored), should have a biopsy performed to determine the diagnosis.Dental Implications: The intraoral melanoma is a deadly lesion that should be recognized and removed in its earliest stage. Early melanomas may be confused with other pigmented lesions such as the blue nevus discussed previously or an amalgam tattoo, and the poor prognosis has been attributed to the fact that there is often a delay in recognizing the lesion as a melanoma. Additionally, there is confusion with other lesions that are benign, causing a delay in treatment. Since pain is not a feature of the lesion, the patient may present at much later stages.Treatment and Prognosis: The rich vascular network found in the oral tissues makes the oral melanoma very aggressive with a much poorer prognosis than melanomas found elsewhere on the body; therefore, any pigmented lesion in the oral cavity should be viewed with suspicion. The growth rate and the tendency of oral melanomas to metastasize remain high. Therefore, early detection and treatment are of extreme importance. Excision of the oral melanoma is the course of action, with wide surgical margins because recurrence is common. Clear margins are critical in this type of neoplasm. Chemotherapy and radiation for head and neck cancers may be used as well, depending upon the size, location, and progressive nature of the lesion. Promising techniques are being used in some forms of cancer with biologic therapy that stimulates or restores the ability of the immune system to fight cancer, infections, and other disease states.
Oral melanomas are associated with a poor prognosis because of the tendency to metastasize to other organs and tissues. Five-year survival rates vary, with reports from 4.5 to 29%.
