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101:Primary Oral Melanoma: The Great Masquerader[AAOM2020}
EP36003
Poster Title: 101:Primary Oral Melanoma: The Great Masquerader[AAOM2020}
Submitted on 29 Mar 2021
Author(s): Andres Davila, DMD & Mahnaz Fatahzadeh, DMD, MSD
Affiliations: Rutgers School of Dental Medicine
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 92
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Poster Information
Abstract: Introduction

Primary oral melanomas are extremely rare and have a high propensity for nodal metastasis and poor survival. The most common locations include palate, maxillary gingiva and mandibular retromolar trigone. Variable appearance and absence of early signs and symptoms often complicates timely diagnosis and worsens prognosis. The likelihood of misdiagnosis and/or delayed diagnosis is compounded for amelanotic melanoma-a variant without classic pigmentation for which diagnosis relies on immunohistochemical staining. We report a patient in whom oral melanoma had distinct amelanotic and discolored components and resembled a reactive lesion.

Case

A 45-year-old white male presented to the oral medicine service for evaluation of an asymptomatic lesion of four-months duration in his left mandible. He was healthy and taking no medications.

Extraoral exam was negative for lymphadenopathy. Notable intraorally was an exophytic gingival mass associated with buccal and distal aspect of tooth #18.The buccal growth was normal mucosal in color, slightly granular in texture and spongy in consistency while the distal component was reddish-grey and firm on palpation. A patchy light-brown discoloration was also present on lingual gingiva of teeth 18 to 21. Clinical and radiographic examination revealed a potential plaque trap on distal of tooth #19 supporting the initial clinical impression of a reactive growth possibly related to local factors. However, color variegation and indurated nature of the posterior growth were atypical and suspicious for a potentially malignant process.

The pink buccal mas biopsied and histopathological examination revealed polygonal malignant cells with variable cytoplasmic volume, pleomorphic and occasionally hyperchromatic nuclei, multiple prominent nucleoli and abnormal mitotic figures. Immunohistochemical staining showed positivity for Melan A, HMB45 and AE1/AE3 diagnosing the malignancy as mucosal melanoma. The patient subsequently underwent oncology work up, left mandibulectomy and neck dissection by the head and neck team. Final pathology confirmed primary oral melanoma with nodal metastasis (PT3N1). Post-surgical radiotherapy and possibly immunotherapy are under consideration by tumor board. Prognosis remains guarded.

Conclusion

Although rare, dental providers should be familiar with the epidemiology, site predilection and variable presentations of melanoma in the oral cavity and include it in the differential diagnosis of gingival growths even when the classic pigmentation is absent.
Summary: We report a patient in whom oral melanoma had distinct amelanotic and discolored components and resembled a reactive lesion.

Ask the author questions about this poster:fatahza@sdm.rutgers.edu

References: 1. Ascierto PA, Accorona R, Botti G, Farina D, Fossati P, Gatta G, Gogas H, Lombardi D, Maroldi R, Nicolai P, Ravanelli M, Vanella V.
Mucosal melanoma of the head and neck. Crit Rev Oncol Hematol. 2017 Apr 112:136-152. doi: 10.1016/j.critrevonc.2017.01.019.
2. Feller L, Khammissa R AG, Lemmer J. 2017. A Review of the Aetiopathogenesis and Clinical and Hisopathological Features of Oral
Mucosal Melanoma. The Scientific World Journal. 2017; https://doi.org/10.1155/2017/9189812.
3. Neville B, Damm D, Allen C, Chi A. 2016. Oral and Maxillofacial Pathology. 4th Edition. St. Louis (MO): Elsevier.
4. Thomas N, Kricker A, Waxweiler W, Dillon P, Busam K, From L, Groben P, Armstrong B, Anton-Culver H, Gruber S et al. 2014.
Comparison of Clinicopathologic Features and Survival of Histopathologically Amelanotic and Pigmented Melanomas A
Population-Based Study. JAMA Dermatol. 2014;150(12):1306-1314. doi:10.1001/jamadermatol.2014.1348
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