Oral mucosal melanomas: the WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology.

A workshop to discuss primary oral melanomas was convened at the annual Western Society of Teachers of Oral Pathology meeting in Bannf, Alberta, Canada. Fifty oral melanomas, identified from the files of the participants, were reviewed in order to better understand the clinical features, histologic spectrum, and natural history of these perplexing lesions. Results confirmed that oral melanomas occur in adults almost three times more frequently in men than women and have a decided predilection for the palate and gingiva. Some lesions exhibit a clinically detectable and prolonged in situ growth phase, whereas others seem to lack this property and exhibit only or predominantly invasive characteristics. Recurrences, metastases, and death from tumor were characteristic of the follow-up of a limited number of patients. Until definitive prospective data are collected that elucidate natural history, oral mucosal melanomas should be tracked separately from cutaneous lesions. All oral pigmented lesions that are not clinically diagnostic should be biopsied. Lesions with equivocal histopathologic features might be referred to as "atypical melanocytic proliferation" and should be excised. Recognition of lesions in an early in situ phase and aggressive treatment should have a favorable effect on prognosis. To enhance future or prospective study of these rare neoplasms, guidelines for reporting oral melanomas are suggested.

Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patients.

Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.

Squamous cell carcinoma of the gingiva.

The similarity of squamous cell carcinoma of the gingiva to periodontal or periapical disease poses problems in diagnosis and management. A case of squamous cell carcinoma of the gingiva is described. It was initially diagnosed as a periodontal lesion and then as a lesion of pulpal origin. This case demonstrates the importance of being highly suspicious of oral conditions, especially those that do not respond promptly to conventional therapy, and shows the value of microscopic examination of all tissues removed during any oral surgical procedure.

Minor salivary gland calculi. A clinicopathologic study of forty-seven new cases.

An analysis of forty-seven previously unreported cases of minor salivary gland calculi revealed that they were usually solitary, firm, freely movable, small masses. Also, we noted that these calculi exhibited a striking predilection for the upper lip and buccal mucosa of adults. The organic matrix of all calculi was similar; however, the amount of mineralized material was variable. A variety of types of epithelial metaplasia was noted in the pericalcular ducts, with the most common type being squamous-cell metaplasia. Chronic periductal and lobular inflammation in addition to duct ectasia were common findings. The cause of minor salivary gland calculi is not known; however, local factors, such as duct morphology or biochemical alterations, or both, may be involved.