Oral Malignant Melanoma Initially Misdiagnosed as a Racial Pigmentation: A Case Report

PRAME immunohistochemistry is useful in the diagnosis of oral malignant melanoma

OBJECTIVES

While the incidence of cutaneous melanoma has dramatically increased in recent years, oral malignant melanoma (OMM) remains a rare form of noncutaneous melanoma with poor survival. PRAME (PReferentially expressed Antigen in MElanoma) is reported to have diagnostic and some prognostic utility in cutaneous melanomas and some head and neck malignancies. We sought to explore the diagnostic utility of PRAME in OMM.

METHODS

A total of ten specimens from eight unique cases of OMM were identified from the Oral Pathology Biopsy Service (OPBS) at University of Washington School of Dentistry between 2005 and 2019. For all cases, standard histology and immunohistochemistry stains were performed, including a stain against PRAME. The diagnoses were reviewed and confirmed by two pathologists. Clinical and epidemiologic features were described.

RESULTS

Patient ages ranged from 55 to 82. The group consisted of five males and three females. All eight cases were located on the hard palate. Six cases represented invasive melanoma while two were early melanoma in situ. PRAME immunohistochemistry was successfully performed on seven of eight cases: six were positive (86%), one was negative (14%) and one case lacked sufficient tissue for staining.

CONCLUSIONS

Our results suggest that PRAME immunohistochemistry may be useful in the diagnosis of OMM, including early melanoma in situ. Further studies with clinical follow-up and a larger number of cases are needed to explore prognostic value as well as the ability to distinguish between benign, intermediate and malignant melanocytic proliferations of the oral cavity.

Black Lives Matter: the impact and lessons for the UK dental profession

Black Lives Matter represents positive action towards equality and inclusivity. The Black Lives Matter protests remind us that, as a society, prejudices and unconscious bias still exist throughout the world. So, how does this inequality impact UK dentistry and what lessons can we learn?Black British dentists and dental care professionals (DCPs) are greatly under-represented in the UK workforce. The cause is multifactorial, but clearly measures need to be made from an early age, as Black prospective students have a 19% acceptance rate into dentistry, compared with 54% white and 41% Asian.As a Black British dental student working with my White British dental tutor, we address barriers that affect Black students and offer recommendations. These struggles are not exclusively related to skin colour, but evidence shows that Black British individuals are more likely to experience detrimental factors.We recognise that it is not the majority that suffer from under-representation, but the minorities; it filters into all aspects of dentistry, including treatment planning and disease diagnosis. Black DCPs and dentists have a contextual understanding of the barriers their communities face and will prove pivotal in workforce diversification. However, we all have a part to play in improving healthcare quality. Together, we can do more.

Palatal Melanoma: "The Silent Killer"

Primary melanoma of the oral cavity is extremely uncommon tumour consisting approximately 0.2 - 8.0% of all melanoma cases and 0.5% of all oral malignancies. It has an aggressive behaviour and poor prognosis, with 5 - year - survival rate between 5 - 20%. The initial symptoms are often unnoticed, which lead to late diagnosis and worsening of the prognosis. Because of its infrequent occurrence, there is no well - defined classification and therapeutic protocol, in contrast to melanomas of another side. Early diagnosis and treatment are essentially linked to survival rate. We present a case of palatal melanoma in a 76 - year - old female patient, as we want to emphasise the importance of the early detection and accurate diagnosis of melanoma of oral cavity, to its influence of the therapeutic outcome.