Which clinical history findings are characteristic of oral malignant melanoma?

Updated: Jan 31, 2020
  • Author: Elizabeth Ann Bilodeau, DMD, MD, MSEd; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Oral melanomas arise silently, with few symptoms until progression has occurred. Most people do not inspect their oral cavity closely, and melanomas are allowed to progress until significant swelling, tooth mobility, or bleeding causes them to seek care. Pigmented lesions 1.0 mm to 1.0 cm or larger are found. Reports of previously existing pigmented lesions are common. These lesions may represent unrecognized melanomas in the radial growth phase.

Amelanotic melanoma accounts for 5-35% of oral melanomas. This melanoma appears in the oral cavity as a white, mucosa-colored, or red mass. The lack of pigmentation contributes to clinical and histologic misdiagnosis. However, the presence of a lymphocytic infiltrate is helpful histopathologically (see Histologic Findings). This host immunologic recognition is most helpful to the pathologist in the diagnosis of both amelanotic and desmoplastic lesions.

Because oral malignant melanomas are often clinically silent, they can be confused with a number of asymptomatic, benign, pigmented lesions. Oral melanomas are largely macular, but nodular and even pedunculated lesions occur. Pain, ulceration, and bleeding are rare in oral melanoma until late in the disease.

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