Melanoma

Melanoma is a malignant neoplasm, originating from melanocytes; it can occur on the skin, the mucosa and the eye. It occurs rarely in the mouth, appearing as a rather dark, pigmented lesion (macula), which is asymptomatic in the initial phases. Subsequently, it can cause blood loss, a loosening of the teeth, swelling and painful ulcers. Its appearance is not homogeneous, with jagged and irregular borders and a nodular consistency. The lesion grows quickly, rapidly invading the surrounding areas with dimensions varying from 1 mm to approximately 1 cm in diameter. Approximately 10% of cases are amelanotic melanoma, that is, melanoma which is devoid of dark pigmentation. The most common sites (primary neoplasm) are the palate and the upper jawbone. In contrast, metastatic melanoma can also be localised in other areas, such as the lower jaw bone, the tongue and oral mucosa. One risk factor implicated in the rise of melanoma is excessive sun exposure; other risk factors (noted for other tumours pertaining to the oral cavity) – such as smoking, alcohol consumption, physical or chemical trauma and poor oral hygiene – have not been confirmed. Diagnosis is confirmed by clinical appearance, a biopsy and histo-pathological examination, and radiological investigations (such as CT and RM). Of note is the fact that, the dabbing of oral melanomas with gauze often elicits a dark pigment. Treatment combines surgery, dissecting the neck for lymphonodal curettage and chemo/radiotherapy. Prognosis correlates with the clinical stages of the neoplasm at the moment of diagnosis, but the survival rate at 5 years is generally less than 50%.