Tumor Size and Depth in Primary Malignant Melanoma in the Oral Cavity Influences Survival

Mücke, Thomas; Hölzle, Frank; Kesting, Marco R.; Loeffelbein, Denys J.; Robitzky, Luisa K.; Hohlweg-Majert, Bettina; Tannapfel, Andrea; Wolff, Klaus-Dietrich

doi:10.1016/j.joms.2008.12.021

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 7 , Pages 1409-1415, July 2009

Tumor Size and Depth in Primary Malignant Melanoma in the Oral Cavity Influences Survival

Thomas Mücke, MD
- Resident, Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, München, and Department of Oral and Maxillofacial Plastic Surgery, University of Bochum, Bochum, Germany
- Address correspondence and reprint requests to Dr Mücke: Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
Frank Hölzle, MD, DDS, PhD
- Senior Consultant, Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, München, and Department of Oral and Maxillofacial Plastic Surgery, University of Bochum, Bochum, Germany
Marco R. Kesting, MD, DDS
- Consultant, Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, München, and Department of Oral and Maxillofacial Plastic Surgery, University of Bochum, Bochum, Germany
Denys J. Loeffelbein, MD, DDS
- Resident, Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, München, and Department of Oral and Maxillofacial Plastic Surgery, University of Bochum, Bochum, Germany
Luisa K. Robitzky
- Graduate Student, Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, München, and Department of Oral and Maxillofacial Plastic Surgery, University of Bochum, Bochum, Germany
Bettina Hohlweg-Majert, MD, DDS
- Consultant, Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar der Technischen, Universität München, München, Germany
Andrea Tannapfel, PhD, MD
- Professor and Head of Department, Institute of Pathology, University of Bochum, Bochum, Germany
Klaus-Dietrich Wolff, MD, DDS, PhD
- Professor and Head of Department, Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, München, and Department of Oral and Maxillofacial Plastic Surgery, University of Bochum, Bochum, Germany

Purpose

Primary oral malignant melanoma (OMM) is rare, and there are few studies examining the impact of this disease. This study aims to assess the outcome of surgically treated patients with OMM treated at a single institution.

Patients and Methods

Ten patients with OMM treated at the Department of Oral and Maxillofacial Surgery, Ruhr-University Bochum, Bochum, Germany, between 1992 and 2002 were analyzed retrospectively. Treatment included wide local excision with or without modified neck dissection, supplemented by radiotherapy and chemotherapy. Clinical and histologic data were analyzed by univariate analysis.

Results

Five patients were diagnosed with stage I disease, 4 with stage II disease, and 1 with stage III disease at presentation. The alveolar arch (40%) and palate (30%) were the most frequently affected sites. The adjusted hazard ratio was 4.513 (95% confidence interval, 1.47-13.89) for size and 1.919 (95% confidence interval, 1.03-3.59) for depth, yielding a poor prognosis (P = .009 and P = .048, respectively). The mean survival rate of the patients succumbing to disease was 19 ± 17 months.

Conclusions

Primary OMM carries a poor prognosis. Early identification of OMM and its treatment by radical surgery comprise the single most important treatment strategy. Any pigmented lesion in the oral cavity not clearly clinically amenable to diagnosis should be excised for histologic confirmation. Analysis of the lymph node status, supplemented by sonography or other imaging, and postoperative histologic evaluation of the size and depth should be performed routinely. In cases in which the mucosal melanoma may not be the primary site, all potential primary sites should be examined.