What is the role of biopsy in the workup 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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The only study effective in diagnosing oral malignant melanoma is a tissue biopsy. Perform a thorough clinical examination and a biopsy of suspicious, unexplained lesions. Surgical lymph node harvest depends on the identification of positive nodes at clinical or imaging examination.

The palate and oral cavity are readily accessible for visual inspection. A pigmented lesion in the oral cavity always suggests oral malignant melanoma. Any pigmented lesion of the oral cavity for which no direct cause can be found requires biopsy. In patients with a previous diagnosis of melanoma, close clinical follow-up with a thorough examination is performed at routinely scheduled appointments.

Sentinel-node biopsy or lymphoscintigraphy, which is beneficial in staging of cutaneous melanoma, has less value in staging or treating oral melanoma. Complex and ambiguous drainage patterns may result in the bypass of some first-order nodes and in the occurrence of metastasis in contralateral nodes.

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