J Korean Assoc Oral Maxillofac Surg.  2018 Apr;44(2):66-72. 10.5125/jkaoms.2018.44.2.66.

Desmoplastic melanoma of the oral cavity: diagnostic pitfalls and clinical characteristics

Affiliations
  • 1Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea. choiomfs@ncc.re.kr
  • 2Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 3Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract


OBJECTIVES
Desmoplastic melanoma of the oral cavity is an extremely rare condition that is often confused on initial diagnosis with non-melanotic benign lesion or spindle cell tumors. The purpose of this article was to raise awareness of the disease using a literature review.
MATERIALS AND METHODS
We analyzed 19 desmoplastic melanoma cases reported in the literature and added our experience. Data on clinical, histopathology, treatment, and survival were retrieved and analyzed. Survival analysis was by the Kaplan-Meier method.
RESULTS
Initial clinical and histopathological features were indistinctive, and a definite diagnosis of desmoplastic melanoma at initial assessment was possible in only 23.5% of cases. Among tests, immunohistochemical studies for S-100 and vimentin were all positive. The 5-year disease-free survival rate for oral desmoplastic melanoma was 0%, and the 5-year overall survival rate was 55.0%.
CONCLUSION
Oral desmoplastic melanoma has a high percentage of initial misdiagnosis and propensity for local recurrence. Thus, careful initial diagnosis and adequate surgery may result in improved overall survival.

Keyword

Oral desmoplastic melanoma; Diagnosis; Recurrence; Survival

MeSH Terms

Diagnosis
Diagnostic Errors
Disease-Free Survival
Melanoma*
Methods
Mouth*
Recurrence
Survival Rate
Vimentin
Vimentin

Figure

  • Fig. 1 Oral desmoplastic melanoma presented as an ulcerative lesion of the left hard palate. The tumor was 1.8×1.5 cm.

  • Fig. 2 Histopathologic appearance of desmoplastic melanoma. A. Spindle-shaped tumor cells of the submucosa with normal-looking squamous epithelium (H&E staining, ×40). B. Junctional activity at the dermoepithelial junction (H&E staining, ×100). C. Submucosal tumor cells with haphazard, fascicular growth pattern with intermixed collagenous stroma. No definite melanin pigmentation is noted (H&E staining, ×100). D. Bland-looking tumor cells with minimal pleomorphism or atypia (H&E staining, ×200).


Reference

1. Conley J, Lattes R, Orr W. Desmoplastic malignant melanoma (a rare variant of spindle cell melanoma). Cancer. 1971; 28:914–936. PMID: 5286448.
Article
2. Magro CM, Crowson AN, Mihm MC. Unusual variants of malignant melanoma. Mod Pathol. 2006; 19(Suppl 2):S41–S70. PMID: 16446716.
Article
3. Feng Z, Wu X, Chen V, Velie E, Zhang Z. Incidence and survival of desmoplastic melanoma in the United States, 1992-2007. J Cutan Pathol. 2011; 38:616–624. PMID: 21518379.
Article
4. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer;2010.
5. Kim UK, Heo JH, Hwang DS, Kim YD, Shin SH, Kim JR, et al. Clinical study on malignant melanoma in oral cavity. J Korean Assoc Oral Maxillofac Surg. 2008; 34:611–615.
6. Batsakis JG, Bauer R, Regezi JA, Campbell T. Desmoplastic melanoma of the maxillary alveolus. J Oral Surg. 1979; 37:107–109. PMID: 283198.
7. Chen JH, Meng CL, Chao LS, Tu CN, Shyu KW. Desmoplastic amelanotic melanoma of palate: a case report with immunohistochemistry and electron microscopic studies. Zhonghua Ya Yi Xue Hui Za Zhi. 1989; 8:80–89. PMID: 2484264.
8. Jain S, Allen PW. Desmoplastic malignant melanoma and its variants. A study of 45 cases. Am J Surg Pathol. 1989; 13:358–373. PMID: 2712188.
9. Kurihara K, Sanada E, Yasuda S, Yamasaki H. Desmoplastic malignant melanoma of the gingiva. Oral Surg Oral Med Oral Pathol. 1992; 74:201–205. PMID: 1508529.
Article
10. Devaraj VS, Moss AL, Briggs JC. Desmoplastic melanoma: a clinico-pathological review. Br J Plast Surg. 1992; 45:595–598. PMID: 1493532.
Article
11. Manganaro AM, Hammond HL, Dalton MJ, Williams TP. Oral melanoma: case reports and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 80:670–676. PMID: 8680974.
12. Ueta E, Miki T, Osaki T, Iwata J, Sonobe H. Desmoplastic malignant melanoma of the gingiva: case report and review of the literature. Eur J Cancer B Oral Oncol. 1996; 32B:423–427. PMID: 9039229.
Article
13. Kilpatrick SE, White WL, Browne JD. Desmoplastic malignant melanoma of the oral mucosa. An underrecognized diagnostic pitfall. Cancer. 1996; 78:383–389. PMID: 8697380.
Article
14. Kavanagh BD, Campbell RL, Patterson JW, O'Neill RL, Cardinale RM, Kaugars GE. Desmoplastic malignant melanoma of the palatal alveolar mucosa: sustained disease-free survival after surgery and postoperative radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89:465–470. PMID: 10760728.
Article
15. Prasad ML, Patel SG, Busam KJ. Primary mucosal desmoplastic melanoma of the head and neck. Head Neck. 2004; 26:373–377. PMID: 15054741.
Article
16. Choi G, Kim JW, Nam SY, Cho KJ. Primary mucosal desmoplastic melanoma of gingiva: a case report. Korean J Pathol. 2006; 40:456–460.
17. Ramani P, Chandrasekar T, Narayanan V, Anuja N, Karthikeyan R, Reddy S, et al. Desmoplastic malignant melanoma of alveolus: a rare entity. Oral Oncol Extra. 2006; 42:291–294.
18. Köseoğlu RD, Aladağ İ, Sezer E, Özkan N. Primary mucosal desmoplastic melanoma of the gingiva. Turk J Med Sci. 2009; 39:483–490.
19. Jou A, Miranda FV, Oliveira MG, Martins MD, Rados PV, Filho MS. Oral desmoplastic melanoma mimicking inflammatory hyperplasia. Gerodontology. 2012; 29:e1163–e1167. PMID: 22612831.
Article
20. Smyth EC, Flavin M, Pulitzer MP, Gardner GJ, Costantino PD, Chi DS, et al. Treatment of locally recurrent mucosal melanoma with topical imiquimod. J Clin Oncol. 2011; 29:e809–e811. PMID: 22010009.
Article
21. Belgaumi UI, Shetty P, Shirlal S. Oral malignant melanoma: a case report of an unusual clinical and histologic presentation. Dent Res J (Isfahan). 2013; 10:404–407. PMID: 24019813.
22. R: a language and environment for statistical computing [Internet]. Vienna: R Foundation for Statistical Computing;Available from: http://www.R-project.org/.
23. Sortino-Rachou AM, Cancela Mde C, Voti L, Curado MP. Primary oral melanoma: population-based incidence. Oral Oncol. 2009; 45:254–258. PMID: 18675580.
Article
24. Chang AE, Karnell LH, Menck HR. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer. 1998; 83:1664–1678. PMID: 9781962.
25. Hicks MJ, Flaitz CM. Oral mucosal melanoma: epidemiology and pathobiology. Oral Oncol. 2000; 36:152–169. PMID: 10745167.
Article
26. Paulo LF, Servato JP, Rosa RR, Oliveira MT, Faria PR, Silva SJ, et al. Primary amelanotic mucosal melanoma of the oronasal region: report of two new cases and literature review. Oral Maxillofac Surg. 2015; 19:333–339. PMID: 25934245.
Article
Full Text Links
  • JKAOMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr