Journal of Prevention and Treatment for Stomatological Diseases ›› 2021, Vol. 29 ›› Issue (12): 843-847.doi: 10.12016/j.issn.2096-1456.2021.12.007

• Clinical Study • Previous Articles     Next Articles

Clinical analysis of 19 cases of oral mucosal malignant melanoma

YANG Hui1(),WANG Xiang1(),ZHANG Lei2,WANG Wenmei1,DUAN Ning1,LI Ruowei1,ZHANG Miaomiao1   

  1. 1. Department of Oral Medicine, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
    2. Department of Oral Pathology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
  • Received:2021-04-16 Revised:2021-05-29 Online:2021-12-20 Published:2021-08-17
  • Contact: Xiang WANG E-mail:2351971968@qq.com;yuwx999@sina.com
  • Supported by:
    National Natural Science Foundation of China(81870767);Special Project in Clinical Medicine of Jiangsu Province(BL2014018);Young Medical Talents Project of Jiangsu(QNRC2016118)

Abstract:

Objective To investigate the clinicopathological features, treatment and prognosis of oralmucosal malignant melanoma to provide a reference for clinical practice. Methods Data from 19 patients with oralmucosal malignant melanoma were collected, and their clinical manifestations, treatment methods and follow-up results were retrospectively analyzed. Results Among the 19 patients, 11 cases (58%) had lesions in the gingiva, 7 cases (37%) had lesions in the palate, and 1 case (5%) had lesions in the tongue, the difference was statistically significant (P<0.05). Eight patients had regional lymph node metastasis with a metastasis rate of 42%, of which 4 cases had multiple site metastasis, and the total number of regional lymph node metastasis sites was 15. Among the 19 patients, 3 cases received only surgery, 4 cases received cryotherapy, and 12 cases received combined surgery, cryotherapy and biological immunotherapy. Pathological examination showed malignant melanoma. The positive rates of S-100, HMB-45 and Melan-A were 95%, 89% and 84%, respectively. Kaplan-Meier survival analysis showed that patients with lesions less than 5 cm2 had a higher survival rate (P < 0.05). Conclusions Oral malignant melanomas usually present as black lesions in the oral mucosa, which are prone to metastasis in early stage. The area of lesions may affect the prognosis of the disease. Therefore, the large range of black lesions or masses should be the alert for the clinicians. Oral malignant melanoma patients are usually treated with combined treatment with surgery, cryotherapy and biological immunotherapy.

Key words: oral, primary malignant melanoma, clinicopathological features, lymph node metastasis, biological immunotherapy, interleukin-2, cryotherapy, surgery, prognosis

CLC Number: 

  • R78

Table 1

Clinical, pathological and immunohistochemical information of 19 patients with oral mucosal malignant melanoma"

Serial
number
Gender Age
(year)
Location Size
(cm × cm)
Regional lymph node metastasis Stage S-100 HMB-45 Melan-A Treatments
1 Male 69 Mandibular gingiva 2.5 × 1.5 None + + + Cryosurgery+Surgery+IL-2
2 Female 49 Dorsum of tongue 2.5 × 2.0 None - + + Cryosurgery+Surgery+BCG+IL-2
3 Male 65 Palate 1.5 × 1.5 None + + + Cryosurgery+Surgery+BCG+IL-2
4 Female 54 Maxillary gingiva 3.5 × 2.5 Left zone Ⅰ, Left zone Ⅱ, Left zone Ⅲ + + + Surgery
5 Male 79 Maxillary gingiva 3.0 × 2.5 None + + + Cryosurgery
6 Male 65 Maxillary gingiva 4.0 × 3.0 None + + + Cryosurgery
7 Male 36 Palate 3.0 × 5.0 Right zone Ⅱ + + + Cryosurgery+Surgery+BCG+IL-2
8 Female 71 Palate 4.0 × 5.0 None + + + Cryosurgery+BCG+IL-2
9 Male 59 Maxillary gingiva 2.0 × 2.0 Zone Ⅰ, Right zone Ⅱ, Zone Ⅲ, Right zone Ⅳ + + + Surgery
10 Male 54 Mandibular gingiva 4.0 × 2.5 Right zone Ⅰ + + + Cryosurgery+Surgery
11 Female 42 Maxillary gingiva 3.0 × 1.5 Zone Ⅰ + + + Cryosurgery+Surgery+BCG
12 Female 46 Palate 5.0 × 3.5 Left zone ⅡB, Left zone Ⅳ + + + Cryosurgery+ Surgery+BCG+IL-2
13 Female 57 Palate 1.5 × 1.0 None + - - Cryosurgery+ BCG+IL-2
14 Female 64 Mandibular gingiva 3.0 × 2.0 None + + + Cryosurgery+BCG+IL-2
15 Female 67 Mandibular gingiva 2.8 × 2.6 Left zone Ⅰ, Zone ⅡA + + + Cryosurgery+Surgery
16 Male 60 Maxillary gingiva 4.0 × 1.5 Zone Ⅱ + + + Surgery
17 Male 63 Palate 3.5 × 1.0 None + - - Cryosurgery
18 Male 69 Maxillary gingiva 4.0 × 4.0 None + + + Cryosurgery
19 Female 25 Palate 1.5 × 1.0 None + + - Cryosurgery+ BCG+IL-2

Figure 1

Malignant melanoma of the left palate The tumor was nodular, brownish black, and covered with white reticulation with satellite lesions seen around. The tumor was asymmetric in shape, unclear in boundary, uneven in color, and more than 10 mm in diameter"

Figure 2

Pathological and immunohistochemical features of oral mucosal malignant melanoma a: tumor cells were disorderly arranged and mainly nested or cord shaped with obvious atypia, different sizes, deep staining of the nucleus, mitotic figures, and melanin deposition between and in cells (HE staining, × 200); b: tumor cells were mainly fusiform (HE staining, × 200); c: HMB-45 (+), × 200; d: S-100 (+), × 200; e: Melan-A(+), × 200"

Table 2

Comparison of the incidence of lesions by gender and location"

Item n(%) χ2 P
Gender Male 10(53) 0.053 0.819
Female 9(47)
Location Gingiva 11(58) 8.000 0.018
Palate 7(37)
Tongue 1(5)

Figure 3

The influence of the area on the survival rate of patients with oral mucosal malignant melanoma Patients with lesions less than 5 cm2 had a higher survival rate (P < 0.05)"

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