Clinical characteristics and factors influencing the prognosis of patients with mucosal melanoma / 肿瘤研究与临床

Objective:To investigate clinical characteristics and factors influencing the prognosis of patients with mucosal melanoma.Methods:The clinical data of 49 patients with mucosal melanoma in Fujian Cancer Hospital from March 2012 to March 2022 were retrospectively analyzed, and their clinical characteristics and prognostic influencing factors were observed. Kaplan‐Meier method was used for survival analysis and Cox proportional risk model was used to analyze the prognostic influencing factors.Results:Female accounted for 61.2% (30/49) of all 49 patients with mucosal melanoma and the median age was 56 years (42-79 years). The most frequent primary tumor sites occurred in head and neck (42.9%, 21/49), followed by the reproductive system (32.7%, 16/49). At the time of initial diagnosis, 81.6% (40/49) of patients had no distant metastasis and 79.6% (39/49) of patients had normal levels of peripheral blood lactate dehydrogenase. The median overall survival time of 49 patients with mucosal melanoma was 39.5 months (95% CI 23.1-55.9 months). The median overall survival time of patients without distant metastasis at the time of initial diagnosis was significantly longer than that of patients with distant metastasis [46.5 months (95% CI 31.6-61.4 months) vs. 19.2 months (95% CI 0-42.2 months, P = 0.025]. There were no statistically significant differences in median overall survival time of patients with different gender, age at the time of initial diagnosis, primary tumor site, and the level of lactate dehydrogenase in peripheral blood at the time of initial diagnosis (all P > 0.05). The presence of distant metastasis at the time of initial diagnosis was an independent risk factor for the prognosis of patients with mucosal melanoma ( HR = 0.379, 95% CI 0.157-0.918, P = 0.032). Conclusions:Mucosal melanoma is more common in female. The most frequent primary tumor sites occur in head and neck. At the time of initial diagnosis, most patients have non‐distant metastasis and the normal level of peripheral blood lactate dehydrogenase. At the time of initial diagnosis, whether there is distant metastasis is an independent influencing factor for the prognosis of patients with mucosal melanoma.

Mucosal melanoma of the male urethra

@#This is a rare case of a mucosal melanoma, located in the urethra of a 59-year-old male. Malignant melanomas of the genitourinary tract are rare, representing <1% of malignancies in the genitourinary tract, and <0.1% of all melanomas. In the male genitourinary tract, the most affected sites are the glans penis and the distal urethra in the fossa navicularis. Urethral melanomas comprise 4% of all urethral cancers.

Clinicopathological features and prognosis of anorectal melanoma: A report of 68 cases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinicopathological characteristics of anorectal mucosal melanoma (ARMM), and to evaluate the prognostic factors.@*METHODS@#A total of 68 primary ARMM surgical specimens from 2010 to 2018 were retrospectively studied. Slides were reviewed to evaluate pathological features. Slingluff staging method was used for staging.@*RESULTS@#(1) Clinical features: The median age at diagnosis in this group was 61.5 years, with a male-to-female ratio 1 ∶1.62. The most common complaint was blooding (49 cases). For anatomic site, anorectum was the prevalent (66.2%), followed by rectum (20.6%). At the time of diagnosis, 28 cases were stage Ⅰ (localized stage, 41.2%), 25 cases were stage Ⅱ (regional lymph node metastasis, 36.8%), and 15 cases were stage Ⅲ (distant metastasis, 22.1%). Five patients underwent wide local excision, the rest abdominoperineal resection, and 48 patients received adjuvant therapy after surgery. (2) Pathological features: Grossly 88.2% of the tumors were exophytic polypoid masses, with the median tumor size 3.5 cm and the median tumor thickness 1.25 cm. Depth of invasion below lamina muscularis mucosae ranged from 0-5.00 cm (median 1.00 cm). The deepest site of tumor invasion reached muscular layer in 27 cases, and perirectal tissue in 16 cases. Melanin pigmentation was absent or not obvious in 67.6% of the cases. The predominant cytology was epithelioid (45 cases, 66.2%). The rate for ulceration, necrosis, lymphovascular invasion, and perineural invasion was 89.7%, 35.3%, 55.9%, and 30.9%, respectively. The median mitotic count was 18/mm2. The positive rate of S100, HMB-45 and Melan-A were 92.0%, 92.6% and 98.0%, respectively. The median of Ki-67 was 50%. The incidences of mutations within CKIT, BRAF and NRAS genes were 17.0% (9 cases), 3.8% (2 cases) and 9.4% (5 cases), respectively. (3) Prognosis: Survival data were available in 66 patients, with a median follow-up of 17 months and a median survival time of 17.4 months. The 1-year, 2-year and 5-year overall survival rate was 76.8%, 36.8% and 17.2%, respectively. The rate of lymphatic metastasis at diagnosis was 56.3%. Forty-nine patients (84.5%) suffered from distant metastasis, and the most frequent metastatic site was liver. Univariate analysis revealed that tumor size (>3.5 cm), depth of invasion below lamina muscularis mucosae (>1.0 cm), necrosis, lymphovascular invasion, BRAF gene mutation, lack of adjuvant therapy after surgery, deep site of tumor invasion, and high stage at diagnosis were all poor prognostic factors for overall survival. Multivariate model showed that lymphovascular invasion and BRAF gene mutation were independent risk factors for lower overall survival, and high stage at diagnosis showed borderline negative correlation with overall survival.@*CONCLUSION@#The overall prognosis of ARMM is poor, and lymphovascular invasion and BRAF gene mutation are independent factors of poor prognosis. Slingluff staging suggests prognosis effectively, and detailed assessment of pathological features, clear staging and genetic testing should be carried out when possible. Depth of invasion below lamina muscularis mucosae of the tumor might be a better prognostic indicator than tumor thickness.

Sinonasal mucosal melanoma: A rare intranasal tumor in an 89-year-old woman

@#Mucosal melanomas are malignant tumors from melanocytes found in epithelium of nasal, oral, reproductive and gastrointestinal mucosa of the body.1,2 As early as 1869, cases of mucosal melanomas have been described as rare and aggressive but insidious in nature.3 The mean age of diagnosis in some studies is 60 - 70 years old,1-7 with early detection proving to be a challenge due to non-specific early stage symptoms.1,4 They generally have poor prognosis, high tumor recurrence and high prevalence of tumor metastasis in around 23 - 50%.4,5 Treatment may involve surgical excision, radiotherapy or chemotherapy.6 However, adequate and appropriate treatment can only be initiated once the diagnosis and staging are established through proper imaging and histopathologic support.4 We present one such case.

Oral Mucosal Melanoma: A Case Report and Literature Review

ABSTRACT: Oral mucosal melanoma is an unusual and aggressive malignant tumor that mainly affects the palate of men aged between 50 and 60 years. We present a literature review focusing on the etiopathogenesis and the clinicopathologic features of this entity. In addition, we reported a rare case of an oral mucosal melanoma arising in the left cheek of a 60-yea r- old man. Computed tomography scan revealed infiltration of the tumor to other anatomic structures including the maxillary sinus, the zygomatic bone and the pterygoid processes. Based on its extension, the lesion was considered inoperable and treatment with three-dimensional conformal radiation therapy was proposed but the patient only attended to the first session and died from cancer progression 6 months after the diagnosis. This paper reinforces the importance of inclusion of this malignant tumor in the differential diagnosis of pigmented lesions of the oral mucosa.

RESUMEN: El melanoma de la mucosa oral es un tumor maligno inusual y agresivo que afecta principalmente al paladar de hombres de entre 50 y 60 años. Presentamos una revisión bibliográfica centrada en la etiopatogenia y las características clínico-patológicas de esta entidad. Además, reportamos un caso raro de melanoma de la mucosa oral que surgió en la mejilla izquierda de un hombre de 60 años. La tomografía computarizada reveló la infiltración del tumor a otras estructuras anatómicas, incluido el seno maxilar, el hueso cigomático y los procesos pterigoideos. En base a su extensión, la lesión se consideró inoperable y se propuso tratamiento con radioterapia conformada tridimensional pero el paciente solo asistió a la primera sesión y falleció por progresión del cáncer 6 meses después del diagnóstico. Este trabajo refuerza la importancia de la inclusión de este tumor maligno en el diagnóstico diferencial de las lesiones pigmentadas de la mucosa oral.

Melanoma nasofaríngeo: caso clínico

Resumen El melanoma mucoso primario (MM) de la cavidad nasal y los senos paranasales sigue siendo un tumor maligno poco frecuente. El pico de incidencia se sitúa entre 50 y 60 años, siendo la epistaxis y la obstrucción nasal unilateral los síntomas más frecuentes. La resección quirúrgica es el tratamiento primario con radioterapia y quimioterapia adyuvante si es necesario, el pronóstico depende de la extensión. Presentamos el caso de una paciente mujer de 81 años con hemoptisis y halitosis de un año de evolución. La nasofibrolaringoscopia mostró una lesión parduzca, excrecente, irregular y friable, en el borde derecho del rodete tubárico derecho. El resultado histopatológico fue MM nasofaríngeo. Perfil inmunohistoquímico: S100 +, MelanA +, HMB45 +, SOX10 +, AE1AE3 negativo. El PET-CT mostró una hipercaptación a nivel del rodete tubárico derecho, sin evidencia de adenopatías o metástasis a distancia. Se realizó la resección tumoral completa mediante abordaje endoscópico. El Comité de Oncología del Melanoma decidió que no era necesario un tratamiento adyuvante debido a la resección completa de la lesión y considerando la edad y el deterioro cognitivo de la paciente.

Abstract Primary mucous melanoma (MM) of the nasal cavity and paranasal sinuses remains a rare malignancy. The peak of incidence is between 50 and 60 years old, being epistaxis and unilateral nasal obstruction the most frequent symptoms. Surgical resection is the primary treatment with radiotherapy and adjuvant chemotherapy if necessary, the prognosis depends on the spreading. We present the case of an 81-year-old female patient attending for hemoptysis and halitosis of a year of evolution. The nasofibrolaryngoscopy showed a brownish, excrescent, irregular and friable lesion, outgrowth of the right tube rim. Histopathology result was nasopharyngeal MM. Immunohistochemical profile: S100 +, MelanA +, HMB45 +, SOX10 +, AE1AE3 negative. PET-CT showed a hypercaptation at the level of the right tube rim, without evidence of adenopathies or distant metastases. Complete tumor resection was performed by endoscopic surgery. Melanoma Oncology Committee decided no need of adjuvant therapy due to the complete resection of the lesion and considering the age and cognitive deterioration of the patient.

Soluble PD-L1 as a prognostic factor for advanced acral and mucosal melanoma / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: Elevated levels of soluble PD-L1 (sPD-L1) are associated with worse prognosis of renal cell carcinoma and multiple myeloma. However, the regulatory roles and functions of sPD-L1 in advanced melanoma are not fully understood. This study was designed to evaluate the association between circulating sPD-L1 concentrations and prognosis of patients with advanced acral or mucosal melanoma. Methods: A total of 102 untreated patients with advanced acral and mucosal melanoma admitted to Peking University Cancer Hospital between January 2012 and December 2015 were enrolled in this study. In the meanwhile, peripheral blood samples were obtained from 40 healthy donors. Circulating sPD-L1 concentrations were determined using an enzyme-linked immunosorbent assay. Results: The advanced melanoma cohort included 58 acral melanoma patients and 44 mucosal melanoma patients. The pre-treatment concentration of sPD-L1 (2.91±2.23 ng/ml) in plasma of patients group was elevated as compared with that in healthy donors (0.59 ng/ml). The concentration of sPD-L1 in serum was significantly upregulated in 39/102 (38.2%) patients and significantly associated with increased LDH level (P=0.021) and number of Tregs (P=0.017). The overall survival rates of patients with high or low concentrations of sPD-L1 were statistically different (8.5 months [high level] vs 11.6 months [low level], P=0.022). Conclusion: sPD-L1 concentration is elevated in patients with advanced acral or mucosal melanoma, which may play an important role in predicting prognosis.

DKC1 affects proliferation, apoptosis and cell cycle of mucosal melanoma cells relating to MEK-ERK pathway / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To investigate the effects of dyskerin pseudouridine synthase 1 (DKC1) on the proliferation, cell cycle and apoptosis of mucosal melanoma cells and its potential mechanisms. Methods: qPCR was used to detect the mRNA expression of DKC1 in mucosal melanoma cell lines HMV II, GAK and normal skin cell line BJ. HMV II and GAK cells were interfered with DKC1 siRNA (si-DKC1 group) and control siRNA(si-Ctrl group) respectively; 48 h later, qPCR and Western blotting were used to verify the interfer‐ence efficiency. CCK-8 assay was used to detect the effect of DKC1 knockdown on the proliferation of mucousal melanoma cells. Flow cytometry was used to detect the apoptosis and cell cycles. Western blotting and qPCR were used to detect the molecule expressions of related pathways. Results: The mRNA and protein expression levels of DKC1 in HMV II and GAK cells were significantly higher than those in BJ cells (all P<0.01). After 48 h of siRNA transfection, compared with the si-Ctrl group, the mRNA and protein levels of DKC1 in HMV II and GAK cells of the si-DKC1 group significantly reduced (all P<0.01), the cell proliferation level significantly re‐duced (P<0.05 or P<0.01), and the apoptosis rate of cells significantly increased (all P<0.01); in addition, the mRNA expressions of proapoptotic molecules caspase 9, BAK and PUMA increased significantly (P<0.05 or P<0.01) and the cell cycle was blocked (P<0.05 or P<0.01); moreover, the phosphorylation levels of MEK and ERK1/2 were significantly reduced (P<0.05). Conclusion: Knockdown of DKC1 can inhibit the proliferation of mucousal melanoma cells, promote cell cycle arrest and induce apoptosis, and its mechanism may be related to MEK/ERK signal pathway.

Melanoma anal, patología infrecuente, reporte de un caso / Anal melanoma uncommon pathology, case report / Melanoma anal, patologia infreqüente, relato de um caso

El melanoma anal (MA) es un tumor infrecuente, caracterizado por presentar un comportamiento agresivo y mal pronóstico(1). La sintomatología inespecífica con la cual se presenta y su similitud con etiologías benignas anorrectales, dificulta el diagnóstico y puede conducir a un retraso en el mismo(2)(3). Por lo tanto, es necesaria una exploración física minuciosa y un elevado índice de sospecha. Se discute el caso de una paciente que consultó por tumoración anal dolorosa, no pigmentada y rectorragia; a la que se le realiza diagnóstico de melanoma anal.

Anal melanoma (MA) is an infrequent tumor, characterized by aggressive behavior and poor prognosis(1). The nonspecific symptomatology and its similarity with benign anorectal etiologies, makes the diagnosis difficult and leads to a delay in it(2)(3).Therefore, a thorough physical examination and a high index of suspicion are necessary. The case of a patient who consulted for a non-pigmented and painful anal mass with rectal bleeding is discussed; which is diagnosed with anal melanoma.

O melanoma anal (MA) é um tumor infrequente, caracterizado por apresentar um comportamento agressivo e ter um mauprognóstico(1). A sintomatologia inespecífica da sua apresentação e a sua similaridade com etiologias benignas anorretais dificultam o diagnóstico e pode levar a um atraso do mesmo(2)(3). Por tanto é necessário uma exploração física minuciosa e um indice de suspeita elevado. Discute-se o um caso de uma paciente que consultou por uma tumoração anal, dolorosa, não pigmentada e retorragia, a qual se realizou o diagnostico de melanoma anal.

Melanoma ano-rectal amelanótico primario. reporte de un caso / Primary amelanotic ano-rectal melanoma. a case report

RESUMEN: Se presenta el caso de una mujer de 37 años, que acude a la consulta por sensación de bulto anal y hematoquecia de 3 meses de evolución, con antecedente de estreñimiento. No presenta prurito, dolor anal ni pérdida de peso. A la inspección, presenta lesión tumoral de 3 cm, en cuadrante superior izquierdo de la región anal, de aspecto denudado, color rosado y mucosa anal hiperpigmentada. La histopatología reporta un tumor de células redondas, sugestivo de melanoma. La inmunohistoquímica confirma finalmente el diagnóstico, pues reporta positividad a los marcadores S100, HMB45 y Vimentina. Al realizar el estudio a los cuatro meses de evolución de extensión de la enfermedad, se encuentran implantes de la neoplasia a nivel pulmonar e inguinal, lo que demuestra la agresividad y el pobre pronóstico de esta patología.

SUMMARY: We present the case of a 37-year-old woman, who came to the clinic for a sensation of anal bulge and hematochezia of 3 months of evolution, with a history of chronic constipation. No pruritus, anal pain or weight loss. On inspection, she presented a 3 cm tumor in the upper left quadrant of the anal region, pink and denuded in appearance. The adjoining mucosa was hyperpigmented. Histopathology reports a round cell tumor, suggestive of melanoma. Immunohistochemistry finally confirms the diagnosis, since it reports positivity to S100, HMB45 and vimentin markers. When performing the disease extension study, implants of the neoplasm are found at the pulmonary and inguinal level, which demonstrates the aggressiveness and poor prognosis of this pathology.

Primary sinonasal mucosal melanoma simulated as cystic lesions: a case report

Sinonasal mucosal melanoma (SNMM) in the maxillary sinus is a rare disease condition. Compared to oral mucosal melanoma, SNMM has a bulky, exophytic, and polypoid appearance, is weakly pigmented, and associated with unspecific symptoms. Due to these features, SNMM in the maxillary sinus has been misdiagnosed as nasal polyps and chronic sinusitis. In this case report, we described SNMM occurring in the right maxillary sinus simulated as a cystic or benign lesion. Cortical bone thinning and expansion were observed around the mass. The excised soft mass was encapsulated and weakly pigmented. The mass was clearly excised and covered with a pedicled buccal fat pad graft. Diagnosis using immunohistochemistry with S-100 and homatropine methylbromide-45 (HMB-45) is critical for proper treatment.

Immunohistochemistry: sole tool in diagnosing a rare case of primary vaginal amelanotic melanoma

We report a rare case of vaginal amelanotic melanoma. Malignant melanomas are cutaneous and extracutaneous tumors that arise from embryological remnants of neural crest cells/melanocytes. Amelanotic melanomas at such rare locations can be misdiagnosed both clinically and radiologically. Therefore, histopathological examination and immunohistochemistry are mandatory for the diagnosis of these tumors. We diagnosed this case using histopathology and confirmed the diagnosis based on the presence of immunohistochemical markers human melanoma black 45 (HMB45) and S-100.

Utilidad de imagen de banda estrecha en un caso de melanoma mucoso de septum nasal / Utility of narrow band Imaging in a nasal septum mucosal melanoma case

En los últimos años, se está utilizando la fibrolaringoscopía con imagen de banda estrecha (NBI) como técnica novedosa para observar el patrón específico de microvas-cularización de una lesión concreta a evaluar. Es conocida por su utilidad en el diagnóstico de otras lesiones de vías aerodigestivas superiores, fundamentalmente laríngea y digestiva. Los melanomas mucosos son tumores infrecuentes, que suelen localizarse a nivel del área rinosinusaly que comportan un manejo y pronóstico distinto con respecto a los melanomas cutáneos. Se presenta el caso clínico de una paciente mujer con anamnesis, exploración y fibrolaringoscopía con imagen de banda estrecha, compatible con melanoma mucoso de fosa nasal izquierda. El tratamiento realizado fue quirúrgico, sin necesidad de tratamiento coadyuvante, y no presenta evidencia de enfermedad al año postseguimiento.

In recent years, it is being used fibrolaryngoscopy with narrowband image (NBI) as a novel technique to observe the specific pattern of microvasculature of a particular lesion. NBI is known for its usefulness in the diagnosis of other lesions of the upper aerodigestive tract, (primarily laryngeal and digestive lesions). Mucosal melanomas are rare tumors, which are usually located at the level of rhino-sinusal area and involving a different prognosis and management regarding cutaneous melanomas. We report a female patient case with anamnesis, clinical examination and NBI compatible with mucosal melanoma of left nostril. Surgical treatmentwas performed without adjuvant therapy, and there is no evidence of disease at one year post-monitoring.

Current status and advances in clinical diagnosis and treatment of mucosal melanoma of the head and neck / 中华放射肿瘤学杂志

Mucosal melanoma of the head and neck (MMHN) is a rare malignancy.The sinonasal cavity and oral cavity are the most common primary sites.MMHN is a very aggressive malignant tumor,with the 5-year overall survival (OS) rate less than 30％.Currently,the optimal treatment modality remains unclear.In the najority of available retrospective studies,postoperative radiotherapy improves the local control of MMHN,but without significant effect on OS.This article aims to improve our understanding of the clinical features,diagnosis,staging,treatment modalities,and outcomes of this malignancy.

Primary mucosal melanoma of the nasal cavity: a linicopathological analysis of 17 cases / 临床与实验病理学杂志

Purpose To study the clinicopathologic features and differential diagnosis of primary mucosal melanoma of the nasal cavity (PMMNC).Methods 17 cases of PMMNC diagnosed from January 2003 to September 2016 were studied by clinical pathological analysis and immunohistochemical staining,and relevant literatures were reviewed.Results 73％ of the PMMNC was characterized by unilateral nasal congestion and intermittent epistaxis and 61％ of the PMMNC occurred in the nasal septum and nasal side wall.Microscopically,the organizational structure and morphology were complex and diverse,which had several cell types including epithelioid cell type (6cases,35.3％),spindle cell type (3 cases,17.6％) and snall cell type (5 cases,29.4％),the other 3 cases (17.6％)were mixed cell type.Mitotic activity and tumor necrosis were more likely to be seen in PMMNC,among other clinicopathological features with a small amount of fibrous stroma and melanoma and rich blood vessels.The immunohistochemical study showed that the positive rate of S-100 and HMB-45 were both 93.8％(15 cases) and those of Melan-A and vimentin were both 87.5％ (14 cases),while CK and EMA were both negative (16 cases).Conclusion PMMNC is a rare disease and the phenotype of S-100,HMB-45,Melan-A and vimentin are useful for diagnosis of PMMNC.

The Prognostic Role of the Surgical Approach and Adjuvant Therapy in Operable Mucosal Melanoma of the Head and Neck

OBJECTIVES: The aim of this study was to investigate the prognostic impact of the surgical approach and adjuvant treatment in operable malignant melanoma of head and neck (MMHN). METHODS: Retrospective reviews of 31 patients who underwent surgery-based treatment with curative intent, either by the endoscopic or external approach, for MMHN were performed to analyze recurrence patterns, salvage modalities, and oncological outcomes (disease-specific survival and disease-free survival). RESULTS: Overall recurrence rate was 61% (19/31). In stage III patients (n=24), 50% (12/24) developed recurrences with a median recurrence-free period of 6.0 months, and 30% (4/12) of them was successfully salvaged by reoperation with adjuvant radiotherapy. On the contrary, all stage IVA patients (n=7) developed recurrences with a median recurrence-free period of 4.4 months. Distant metastasis was the most common pattern of failure and no patients were salvaged. Among variables, age and T classification, not the surgical approach, were significant prognosticators for disease-free survival and disease-specific survival. Adjuvant radiotherapy was associated with a lower rate of local failure, compared to surgery alone (hazard ratio, 0.02; 95% confidence interval, 0.06 to 0.75; P=0.02). However, adjuvant systemic therapy was not effective in reducing the risk of failures for any pattern. CONCLUSION: Our data suggested that meticulous surgical resection, either by the endoscopic or external approach, with adjuvant radiotherapy increases the local control rate in MMHN.

Primary Mucosal Melanoma of Maxilla: A Case Report and Review of Literature.

Oral malignant melanomas are extremely rare lesions and occur commonly in the maxillary gingiva more frequently on the palate with fewer incidences in the mandibular gingiva. Malignant melanomas of oral cavity are extremely rare accounting for 0.2-8% of all malignant melanomas. A 51-year-old female reported a growth about left maxillary region with black pigmentation in anterior maxillary region and palatal region. Differential diagnosis of gingival hyperplasia, giant cell epulis, Kaposi’s sarcoma and malignant melanoma were kept. Histopathological sections showed sheets of pleomorphic spindle cells with intracytoplasmic Brown-black pigment, involving the lower part of the squamous epithelium. Tumor cells were positive for S-100 and a human melanoma black-45 immunostain, and a diagnosis of malignant melanoma was rendered. The patient underwent partial maxillectomy on left side and the case was categorized as Stages I level III. Complete excision with adequate negative margins is the treatment of choice. Malignant melanoma is relatively insensitive to radiation; hence, the role of radiotherapy is not well-defined. The tendency to invade and cause early hematogenous metastasis results in poor prognosis. The most common cause of treatment failure is Nodal involvement and multiple local recurrences.

Oral Mucosal Amelanotic Melanoma: A Rare Case Report.

Oral cancer is a major global health problem. It is ranked as the third most common cancer in India. More than 95% of oral cavity carcinomas are of squamous cell type. Melanoma is a major health problem and originates from the malignant transformation of melanocytes. Primary mucosal melanomas of the head and neck occur less frequently than their cutaneous counterparts. Among those, oral mucosal melanoma is extremely infrequent with an incidence of 0.5% of oral neoplasms. Less than 2% of all melanomas lack pigmentation, in the oral mucosa, however, up to 75% of cases are amelanotic melanomas. Th ese are extremely rare variants and the most frequent sites in the oral cavity are the hard palate and the gingiva. Lesions that are suspected to be melanomas should be assessed both histologically and by immunohistochemistry, which are helpful in the diagnosis of amelanotic melanoma. Th ey have a poorer prognosis than the pigmented melanomas because of the delay in diagnosis and in the initiation of treatment. Th is presentation is a rare case report of oral mucosal amelanotic melanoma.

Two Cases of Lentigo Maligna with Atypical Clinical Presentation / 대한피부과학회지

Lentigo maligna is a variant of melanoma in situ that appears on sun-exposed areas as a macule with variegated pigmentation and irregular borders. If untreated, it has a risk of progressing to lentigo maligna melanoma. Two patients presented with hyperpigmented macules or patches on atypical facial areas. The histological findings were consistent with lentigo maligna. An 80-year-old Korean woman presented with clustered hyperpigmented macules on the lower lip and oral mucosa, and a 45-year-old Caucasian presented with a lesion located on the external auditory meatus, with intermittent sun exposure. Herein, we report two interesting cases of lentigo maligna with atypical clinical presentations.

Melanomas no cutáneos de cabeza y cuello enfermedad de pronóstico sombrío / Non-cutaneous melanoma of the head and neck disease of grim prognosis

Antecedentes: Los melanomas no cutáneos representan el 1-7% del total. Su pronóstico es malo, a pesar de lo cual, los avancestecnológicos pueden haber cambiado su evolución.Objetivo: Descubrir factores que permitan determinar los progresos de los últimos 20 años.Diseño: Retrospectivo, observacional.Lugar de aplicación: Hospital Público de atención terciaria.Población: 30/56 pacientes pertenecían al género masculino, con una relación 1.15/1. La edad media fue 61.07 años. El sitiodominante de los mucosos fue paladar con 22 (39.2%) y senos paranasales con 9 (16%). Los oculares con 24/56 representaron el(42.8%) de la muestra. El 94.6% se hallaban en E I.Métodos: La extensión de la cirugía varió desde la simple resección local en 13/56 -23.2%- pacientes, a la enucleación ocular en14/56 (25%), exenteración orbitaria en 5/56(9%), maxilectomía superior en 20/56 (35.7%), resección craneofacial en 3 y amputaciónnasal en 1.Resultados: La morbilidad fue 51.7% y la mortalidad 1.7%. El 67.8% desarrolló recurrencias. El análisis univariado para recurrenciademostró que los orígenes rinosinusal y conjuntival, influyeron desfavorablemente en el evento recurrencia. Al cierre de laobservación 42/56 (75%) habían fallecido, (85.8%) de ellos por causa específica. Solo 2/42 (4.7%) muertes se produjeron despuésde los 60 meses. La supervivencia libre de enfermedad a 5 años fue 31.9%. El paladar y el E I, fueron las variables que a su favorconservaron significación estadística.Conclusiones: Urgen nuevos paradigmas de tratamiento para esta enfermedad cuya evolución no se ha modificado sustancialmenteen los últimos 20 años.

Background: Non cutaneous are 1-7% of all melanoma. The prognosis is poor in spite of which, technological progress maychange the outcome.Objective: To discover factors which allow to define progress of last 20 years.Design: Retrospective, observational.Setting: Public Hospital of tertiary care.Population: 30/56 male patients with 1.15/1 rate. Mean age 61.07 years old. Priority sites in mucosal melanoma were palate with22-39.2% and paranasal sinus with 9 (16%). Ocular melanomas were 42.8% of the sample. 94.6% were EI.Methods: Extention of surgery was simple resection in 13/56 (23.2%), ocular enucleation in 14/56 (25%), orbit exenteration in 5/56(9%) maxilectomy in 20/56 (35.7%), craniofacial resection in 3 and nasal amputation in 1.Results: Morbility was 51.7% and mortality 1.7%. 67.8% of the sample recurred. Multivariate analysis for recurrence showed thatrinosinusal and conjuntival sites unfavorably influence on that event. At close of observation 42/56 (75%) was dead, 85.8% of themfor specific cause. Only 2 death happened after 60 months. Five years specific survival was 31.9%. Palate and stage I were favorablesites with statistic significance.Conclusions: Other paradigms of treatment are urgently necessary for this disease which outcome was not substantially modifiedin the last 20 years.