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

• Min SK
• Jeong JH
• Ahn KM
• Yoo CW
• Park JY
• Choi SW

• KMID: 2410582
• DOI: http://doi.org/10.5125/jkaoms.2018.44.2.66

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

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

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  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).

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