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.

As principais lesões enegrecidas da cavidade oral / Las principales lesiones ennegrecidas en cavidad oral / Main blackened lesions of the oral cavity

Introdução: as lesões pigmentadas podem ser encontradas na cavidade oral, essas pigmentações são provenientes de diversos fatores, tais como, locais, sistêmicos, fisiológicos ou patológicos. A cor, localização, distribuição e duração são características essenciais para o diagnóstico destas lesões, não devendo- se negligenciar a história médica, odontológica e familiar, bem como o consumo de drogas. Apesar de algumas lesões apresentarem características bastante específicas que as confere um diagnóstico apenas através do exame clínico, é importante que o profissional lance mão de métodos adicionais, como biópsias e exames laboratoriais, afim de alcançar um diagnóstico confiável e consequentemente, executar o tratamento adequado. Objetivos: essa revisão de literatura tem como objetivo discorrer sobre as principais lesões orais enegrecidas da cavidade oral, enfatizando o diagnóstico diferencial para cada uma delas, já que tal abordagem implicará diretamente na conduta profissional e no estabelecimento do tratamento adequado para cada paciente. Métodos: para isso foi realizada uma revisão de literatura através da busca de artigos no PubMED/Medline, Lilacs e Scielo. Resultados: a literatura estudada destacou que as lesões pigmentadas orais e maxilofaciais podem clinicamente simular o melanoma, uma lesão maligna. Conclusões: devemos ter especial atenção durante o exame clínico deste tipo de ocorrência, saber questionar o paciente para obter informações importantes a respeito da lesão, ter conhecimento dos diferentes tipos de lesões pigmentadas que acometem a cavidade oral e face, assim como ter em mente a necessidade do exame histopatológico para se obter o diagnóstico definitivo de lesões pigmentadas suspeitas(AU)

Introducción: las lesiones pigmentadas que se encuentran en la cavidad bucal pueden provenir de diversos lugares, tales como de la localidad, sistémicas, fisiológicas o patológicas. El color, la localización, la distribución y la evolución clínica son características esenciales para el diagnóstico de estas, sin pasar por alto la historia médica, la odontológica o familiar, y sin menospreciar el consumo o no de drogas. A pesar de que algunas lesiones presentan características bastante específicas que permiten establecer un diagnóstico acertado con solo un examen clínico, es importante que el profesional tenga en cuenta métodos adicionales, como biopsias y exámenes de laboratorio, con la finalidad de obtener un diagnóstico confiable y consecuentemente ejecutar un tratamiento adecuado. Objetivos: en esta revisión bibliográfica se pretende describir las principales lesiones orales pigmentadas en cavidad bucal, enfatizando el diagnóstico diferencial para cada una de ellas, ya que tal abordaje de ellas recae directamente en la conducta del profesional, asi como también el plan de tratamiento adecuado para cada caso. Métodos: se realizó una revisión de la literatura a través de los buscadores PubMed/Medline, Lilacs y Scielo. Resultados: en esta revisión se destaca que las lesiones pigmentadas bucales y maxilofaciales pueden simular clínicamente un melanoma o una lesión maligna. Conclusiones: se debe tener especial cuidado durante el examen clínico en este tipo de lesiones, saber cómo interrogar al paciente para obtener información contundente con respecto al caso estudiado, tener conocimiento de los diferentes tipos de lesiones pigmentadas que podrían encontrarse en la cavidad bucal y en la cara, así como también la necesidad de un examen histopatológico para poder obtener un diagnóstico definitivo preciso en estas lesiones pigmentadas sospechosas(AU)

Introduction: pigmented lesions of the oral cavity may be due to local, systemic, physiological or pathological factors. Diagnosis of these lesions is largely based on their color, location, distribution and clinical evolution, alongside other characteristics, such as medical, dental or family antecedents and drug use. Despite the fact that some lesions exhibit rather specific features allowing accurate diagnosis in just one clinical examination, other procedures should also be performed, such as biopsies and laboratory tests, to reach a reliable diagnosis and apply the appropriate treatment. Objectives: the present bibliographic review is aimed at describing the main pigmented lesions of the oral cavity with emphasis on their differential diagnosis, an important element in their clinical management and treatment. Methods: abibliographic review was conducted in databases PubMed/Medline, Lilacs and Scielo. Results: the review revealed that oral and maxillofacial pigmented lesions may clinically simulate a melanoma or malignant lesion. Conclusions: special attention should be paid to these lesions during clinical examination. Appropriate questions should be asked of patients in order to obtain relevant information about the case under study, acquire knowledge about the different types of oral and facial pigmented lesions, and determine the need for histological examination to reach an accurate final diagnosis(AU)

Progressive Zosteriform Macular Pigmented Lesion / 대한피부과학회지

A progressive zosteriform macular pigmented lesion (PZMPL) is a chronic pigmentary dermatosis similar to progressive cribriform and zosteriform hyperpigmentation (PCZH), but characteristically accompanied by pruritus as a prodromal symptom and histologic findings, such as pigmentary incontinence. PZMPL was described by Simoes in 1980 and manifests a uniformly tanned macular pigmented lesion in a zosteriform distribution. PZMPL is usually preceded by multiple pruritic macular pigmentation in a part of the dermatome for a period of time. Despite the difficulty in differentiation among other pigmentary disorders with unilateral distribution, such as linear and whorled nevoid hypermelanosis, partial unilateral lentiginosis, and Becker's melanosis, PZMPL can be diagnosed by clinical symptoms and signs, the pattern of lesions, and histologic features. A 6-year-old Korean girl presented with unilaterally located brown macules and patches on the left side of the chest, arm, and back. From childhood, the pigmented macules appeared and coalesced into patches on the left back. The arm and chest lesions extended along the Blaschko's line in a zosteriform distribution. She had no history of previous skin diseases, injuries, or inflammation. The histologic findings revealed increased melanin pigment in the basal layer and focal pigmentary incontinence in the upper dermis. We report a rare case of PZMPL thought to be the same case reported by Simoes.

Pigmented ‘black’ adenoma: a rare cause of conn’s syndrome

Presence of a hypofunctioning pigmented adenoma are commonly asymptomatic and is usually only found during an autopsy. In contrast, hyperfunctioning pigmented adenoma is a rare clinical entity and in the majority of cases results in Cushing‟s syndrome. In this case study, we report a 66-year-old male who presented instead with the clinical and biochemical features of Conn‟s syndrome. On laparoscopic adrenalectomy, it was found that the tumour had a functioning black adenoma which does not usually present with Conn‟s syndrome but rather to that of a Cushing‟s. The intraoperative changes and histopathological findings are discussed.

Standard guidelines of care: Lasers for tattoos and pigmented lesions.

Introduction: Lasers have revolutionized the treatment of pigmentary disorders and have become the mainstay of therapy for many of them. Machines: Though different laser machines are used, Quality-switched (QS) lasers are considered as the gold standard for treatment of pigmented lesions. Proper knowledge of the physics of laser machine, methodology, dosage schedules, etc., is mandatory. Physician Qualification: Laser may be administered by a dermatologist, who has received adequate background training in lasers during postgraduation or later at a center that provides education and training in lasers, or in focused workshops which provide such trainings. He should have adequate knowledge of the machines, parameters, cooling systems, and aftercare. Facility: The procedure may be performed in the physician's minor procedure room. Indications: Epidermal lesions: Cafι au lait macules (CALM), lentigines, freckles, solar lentigo, nevus spilus, pigmented seborrheic keratosis, dermatosis papulosa nigra (DPN). Dermal lesions: Nevus of Ota, Blue nevus, Hori's nevus (acquired bilateral nevus of Ota-like macules). Tattoos: Amateur, professional, cosmetic, medicinal, and traumatic. Mixed epidermal and dermal lesions: Postinflammatory hyperpigmentation (PIH), nevus spilus, periorbital and perioral pigmentation, acquired melanocytic nevi (moles), melasma and Becker's Nevus. Contraindications: Absolute: Active local infection, photo-aggravated skin diseases and medical conditions, tattoo granuloma, allergic reactions to tattoo pigment, unstable vitiligo and psoriasis. Relative: Keloid and keloidal tendencies, patient on isotretinoin, history of herpes simplex, patient who is not co-operative or has unrealistic expectation. Patient selection: Proper patient selection is important. Investigations to identify any underlying cause for pigmentation are important; concurrent topical and systemic drug therapy may be needed. History of scarring, response to previous injuries, degree of tanning needs to be considered. Detailed counseling about the need for multiple sessions is required. Informed consent should be taken in all cases. Treatment sessions: Epidermal lesions need an average of 1−6 sessions, while dermal lesions need average of 4−10. Some tattoos may need up to 20 sessions. All lesions may not clear completely and only lightening may be achieved even after multiple sessions in many cases. Future maintenance treatments may be needed. Hence, a realistic expectation and proper counseling is very important. Epidermal lesions are likely to recur even after complete clearing. Therefore, there is a need for continued sun protection. Dermal lesions and tattoos tend to remain clear after treatment (except conditions as dermal melasma). Laser parameters: Laser parameters vary with area, type of pigmentation and machine used. Complications and their management: Postinflammatory pigmentation changes are common in dark skin patients. Textural changes and scarring occur rarely.

The curative effects of pigmented dermatosis treated with YQ400A/B-I Laser / 重庆医科大学学报

Objective:To investigate the effectiveness of familiar pigmented dermatosis on face which treated with YQ400A/B-I Laser. Methods:Pigmented dermatosis were selected to be treated with YQ400A/B-I Laser. Retrospect 479 cases witch been reviewed during 6 months or 2 years in total 568 patients. Results:A total of 479 cases were treated with the therapy,yielding effective rate of 100% in fleck (273 cases),100% in CAL(23 cases),90.20% in age pigment(51 cases). 76.12% in chloasma(67 cases)and 98.46% in congenital melanocytic nevus (65 cases)with no obvious complications. Conclusion:YQ400A/B-I Laser has been proved to be an effective and satisfactory way to treat pigmented dermatosis.

Clinicopathologic Study of Labial Melanotic Macule

BACKGROUND: Labial pigmented lesions include labial melanotic macule, ephelids, lentigo, venous hemangioma, amalgam tattoo, junctional nevus, Peutz-Jeghers syndrome, Addison's disease, Laugier s disease, and superficial spreading melanoma. OBJECTIVES: The purpose of this study was aimed at investigating the clinical and histopathological characteristics of labial melanotic macule during the past 10 years. METHODS: Clinical information of 49 patients with pigmented lesion of the lips diagnosed in Asan Medical Center from 1989 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated all the biopsy specimens obtained from the patients. RESULTS: Twenty-six patients with labial melanotic macule were enrolled in this study. There were 16 women and 10 men. Age at onset varied from 20 to 65 years in women and from 28 to 68 years in men. The duration of the lesion ranged from 4 months to 12 years (mean, 4.5 years). The majority of patients had solitary lesions on the lower lip. Histopathologic examination of biopsy specimens showed increased pigmentation of the basal layer, mild acanthosis without elongation of rete ridges, and scattered melanophages in the dermis. CONCLUSIONS: We suggest that labial pigmented lesions appearing in adults should be biopsied and labial melanotic macule should be diagnosed after the histopathological examination.