Evolution of maxillofacial brown tumors after parathyroidectomy in primary hyperparathyroidism.

BACKGROUND: Brown tumor occasionally affects the facial bones. Clinically, these lesions can be mistaken for a neoplasm. Opinions are divided on the course of management of the bony lesions once parathyroidectomy has been carried out. METHODS: We treated 22 patients with primary hyperparathyroidism and osteitis fibrosa cystica and observed their clinical and biochemical recovery. RESULTS: Fifteen patients (68.2%) had brown tumors in mandible, and 7 (31.8%) in maxilla. After parathyroidectomy, 21 patients had normal total serum calcium values. All brown tumors presented a spontaneous progressive regression; in 18 cases, regression was total, with a mean time period of 10 months. Two patients had partial regression after nearly 2 years. Another 2 patients were lost to follow-up. CONCLUSIONS: After successful parathyroid surgery, the bony lesions tended to regress spontaneously, either partially or completely. However, if the lesion is disfiguring or symptomatic, surgical excision may be indicated.

[Primary melanoma of the oral mucosa. Experience of the Oncology Hospital of Centro Médico Nacional Siglo XXI]. / Melanoma primario de la mucosa oral. Experiencia del Hospital de Oncología.

BACKGROUND: Primary intraoral melanoma is extremely rare and carries a poor prognosis. Treatment of choice remains controversial. Our aim was to define the clinical features of this disease and to evaluate treatment methods. METHODS: We retrospectively studied 14 patients with primary malignant melanoma of the oral cavity seen at the Oncology Hospital of the Mexican Institute of Social Security (IMSS), 21st Century National Medical Center (CMN-SXXI) between 1991 and 2005. The main variables studied were clinical findings, response to therapy, and outcome. RESULTS: In five males (35.7%) and nine females (64.3%) with a mean age of 65 years, tumor locations included hard palate (nine cases), maxillary gingiva (three cases), hard/soft palate (one case) and lip (one case). Pre-existing melanotic pigmentation was present in two patients. Nine patients were in stage I, four in stage II, and one was in stage III. Surgical excision was the primary treatment in 11 cases; four patients underwent simultaneous neck dissections. All patients in stage II received adjuvant radiation therapy. After a 3-year follow-up, three patients of those presenting stage I are still alive (33.3%, 3/9 cases), and all patients in stages II and III eventually died of the disease. CONCLUSIONS: Early diagnosis of pigmented lesions in the mouth along with adequate tumor resection may improve the prognosis of this disease; however, in advanced disease stage it may be reasonable to infer that major improvements in outcome after treatment of malignant melanoma of the oral cavity may not be carried out until more effective systemic therapy becomes available.