Metastatic melanoma misdiagnosed as a temporomandibular disorder: a case report and review of the literature

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.

The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders

The causes of pain symptoms in the temporomandibular joint (TMJ) and masticatory muscle (MM) regions may not be determined by clinical examination alone. In this review, we document that pain symptoms of the TMJ and MM regions in patients with temporomandibular disorders (TMDs) are associated with computed tomography and magnetic resonance (MR) findings of internal derangement, joint effusion, osteoarthritis, and bone marrow edema. However, it is emphasized that these imaging findings must not be regarded as the unique and dominant factors in defining TMJ pain. High signal intensity and prominent enhancement of the posterior disk attachment on fat saturation T2-weighted imaging and dynamic MR imaging with contrast material are closely correlated with the severity of TMJ pain. Magnetic transfer contrast, MR spectroscopy, diffusion tensor imaging, and ultrasonography findings have helped identify intramuscular edema and contracture as one of the causes of MM pain and fatigue. Recently, changes in brain as detected by functional MR neuroimaging have been associated with changes in the TMJ and MM regions. The thalamus, the primary somatosensory cortex, the insula, and the anterior and mid-cinglate cortices are most frequently associated with TMD pain.

Neuralgia associated with transcutaneous electrical nerve stimulation therapy in a patient initially diagnosed with temporomandibular disorder

Head and neck neoplasms may be difficult to detect because of wide-ranging symptoms and the presence of overlapping anatomic structures in the region. This case report describes a patient with chronic otalgia and temporomandibular disorder, who developed sudden-onset neuralgia while receiving transcutaneous electrical nerve stimulation (TENS) therapy. Further diagnostic evaluation revealed a skull base tumor consistent with adenoid cystic carcinoma. To our knowledge, this is the first report of TENS-associated neuralgia leading to a diagnosis of primary intracranial adenoid cystic carcinoma.