The purpose of this study was to evaluate the clinical, pathological, and therapeutic experience of a group of patients with primary oral malignant melanoma (OMM) in Amsterdam, The Netherlands.
Patients and Methods
Fourteen patients (5 males, 9 females, mean age 57.9 years) with histopathologic diagnosis of OMM were treated at the Department of Oral and Maxillofacial Surgery/Oral Pathology of the Vrije University Medical Center in Amsterdam between 1978 and 2005. A pigmented, flat or swollen, irregularly bordered lesion of oral mucosa was detected in most patients during the first clinical examination. Pain was the most commonly referred symptom; the palate was the most frequently affected subsite. Following the mucosal melanoma microstaging system, all patients staged as stage I (T any N0M0) could be subclassified as microstage II (invasion up to the lamina propria), except for 1 patient microstaged as stage III (deep skeletal tissue invasion into skeletal muscle, bone, or cartilage). Where possible, surgery was the treatment of choice. Postoperative radiotherapy, using fractions of 6 Gy twice a week for a total dose of 30 Gy, was given to 3 patients. Three patients were treated primarily with radiotherapy alone.
Results
Five patients developed local recurrence within 4 to 72 months, and 10 patients developed distant metastases within 6 to 78 months. Ten patients died of their disease within an average interval of 40 months, with a range of 12 to 80 months. Of the 10 patients who qualified for evaluation of the 5-year-survival rate, 1 was alive with disease and 2 were alive without evidence of disease, resulting in a 5-year survival rate of 30%. However, all patients died of their disease before the end of the 10-year follow-up period.
Conclusion
Our study confirms that OMM is a rare and aggressive malignancy with a low 5-year survival rate. An evidence-based protocol for the best therapeutic approach is not yet available.
⁎PhD Student, Unit of Oral Pathology and Medicine, Section of Odontostomatology, Department of ENT/Dental/Ophthalmological and Cervico-Facial Sciences, University of Parma, Parma, Italy; and Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.
†Professor and Department Head, Department of Otolaryngology/Head and Neck Surgery, Vrije University Medical Center, Amsterdam, The Netherlands.
‡Professor, Department of Pathology, Vrije University Medical Center, Amsterdam, The Netherlands.
§Professor and Department Head, Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.
Address correspondence and reprint requests to Dr van der Waal: VUmc/ACTA, PO Box 7057, 1007 MB Amsterdam, The Netherlands
ABSTRACT