Metastatic melanoma of the tongue: a case report with immunohistochemical profile

Tongue metastasis of malignant melanoma: A case report and a systemic review of the literature

OBJECTIVES

The incidence of malignant melanoma, with potential for tongue metastasis, is increasing. This study presents a case of tongue metastasis of cutaneous malignant melanoma, along with a comprehensive systematic review of the cases presented in English literature. The aim is to increase clinical and pathological knowledge of these challenging cases.

MATERIALS AND METHODS

The literature search was carried out according to PRISMA guidelines by two independent researchers using four online databases: Medline, PubMed, Web of Science and Scopus.

RESULTS

Altogether 24 cases of tongue metastasis of malignant melanoma were observed (mean age 54.9 years, range 27-86 years). The average time from the primary tumour to tongue metastasis was 4.5 years. The metastatic tumour was generally indolent or mildly symptomatic. The most prevalent clinical presentation was a submucosal, non-ulcerated tumour mass, located in the tongue base or lateral surfaces. The prognosis at the time of tongue metastasis was generally poor, with a mean survival of 2.9 months.

CONCLUSION

Considering the mild symptoms, varying age of the subjects and interval from the initial diagnosis, a comprehensive anamnesis and regular oral examination should be emphasized, and metastatic malignant melanoma considered in cases of lingual tumour.

An unusual case of melanoma metastasis in the buccal space: learning by mistakes to distinguish it from salivary neoplasms

BACKGROUND

The buccal space is an unusual location of malignancies. We report here the case of a woman with a melanoma metastasis in buccal fat pad, to evaluate the imaging features which might lead to the correct, although uncommon, diagnosis.

CASE PRESENTATION

A 71-year-old woman presented with a painless visible swelling of the left cheek. MRI revealed the presence of a solid lesion located in the buccal fat pad with features suggestive of malignancy. It showed T1 hyperintensity and T2 hypointensity, and restriction of diffusion. Histological examination showed neoplastic cells compatible with melanoma.

DISCUSSION

The lesion features (T1 hyperintensity and T2 hypointensity) initially lead our team to believe that there was a hemorrhagic component, possibly a residue of the biopsy. However, when associated with other malignancy features, such as low apparent diffusion coefficient (ADC) values and contrast enhancement, they should evoke the suspect of melanoma, provided that no biopsy was performed and no trauma occurred in the 3-7 days before.

Tongue metastasis of cutaneous melanoma: Report of two cases and literature review

Introduction

Malignant metastases to the oral cavity are rare and metastatic melanomas of the tongue are considered exceptionally uncommon, with less than 10 cases published in the English literature so far.

Case reports

Two female patients in the 7th decade of life presented to our dental service with nodules in the tongue. Both patients had multiple metastases at the time of oral diagnosis and primary melanoma originated on the skin. An intra-oral incisional biopsy was performed under local anesthesia and the histopathologic analysis was characterized by the proliferation of atypical epithelioid cells displaying a poorly delimited cytoplasm and hyperchromatic nucleus which contained eosinophilic macronucleoli. Immunohistochemistry was performed in both cases to confirm the clinical hypothesis of metastatic melanoma. After the diagnosis of oral metastatic melanoma, the patients were maintained under palliative care and close medical follow-up. Both patients died four and a half months and 20 months after the diagnosis of tongue metastasis.

Conclusions

Although rare, metastatic melanoma should be included in the differential diagnosis of tongue lesions detected in patients with a previous medical history of cutaneous melanoma.

Key words:Melanoma, tongue, metástases.

Metastasis to the oral soft tissues: A review of 412 cases

The present review article analyzes the characteristics of metastases to the oral soft tissues from 1937 to 2015. An extensive literature search was performed. All variables such as age, gender, and primary and secondary tumor sites were analyzed. Metastases to the major salivary glands were not included in this review. In general, there were 412 metastatic lesions developed in the oral soft tissues. The male-to-female ratio was approximately 1.8:1. The mean age of the patients at diagnosis was 58. The lung was the most common primary site and the gingiva was the most common metastatic site. The greater part of the histological examination yielded adenocarcinoma. The diagnosis of a metastatic lesion in the oral cavity is a challenge to the clinicians due to the lack of pathognomonic signs and symptoms. Oral metastases usually occur in the advanced stages of cancers, and the interval between appearance and death is usually short. The oral soft tissue metastasis can be easily recognized compared to the metastasis of jawbones. Early detection of oral lesions is important in the case of being the first sign of a malignancy in other parts of body.

Primary Malignant Melanoma of the Lip: A Report of 48 Cases

PURPOSE

Lip melanoma (LM) is a rare malignant tumor and well-established treatment protocols for it are in short supply. The objective of this study was to evaluate the outcome of treatment modalities and explore the prognostic factors.

PATIENTS AND METHODS

A retrospective chart review was performed on 48 patients with primary LM treated in the authors' hospital from January 1992 to November 2013. The clinical characteristics and treatment modalities were identified and correlated with the outcomes.

RESULTS

The 5-year overall survival (OS) rate was 56.1%, and the rate of cervical lymph node (CLN) metastasis was 46% (22 of 48). A tumor of at least 4 cm (P = .001), nodular types (P = .003), and CLN (P < .0001) were independent prognostic factors for OS. Twenty-five patients died during follow-up, mainly from to neck recurrence (14 of 25). Chemotherapy significantly improved the 5-year OS rate in patients with stage IV LM (P = .03), but not in those with stage III (P = .8).

CONCLUSIONS

LM has a lower CLN and distant metastasis rate and a better prognosis than other oral mucosal melanomas. A long history of melanin pigmentation is a dangerous sign for all patients, and smoking seems to be associated with LM in male patients. Tumor size (≥4 cm), nodular type, and CLN positivity are poor prognostic factors. A wide excision with close observation is advocated as the primary treatment for stage III LM. Adjuvant chemotherapy is useful for patients with stage IV cancer, but not for those with stage III.