Which specialist consultations are beneficial to patients with 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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Answer

Answer

Consult the following specialists and facilitate their meeting during head and neck tumor boards to plan the best therapy and aftercare for patients with oral melanoma:

  • Ear, nose, and throat (ENT) surgeon

  • Pathologist (eg, dermatopathologist and general surgical, head and neck, or oral and maxillofacial specialist)

  • Medical and radiation oncologists

  • Maxillofacial prosthodontists

  • Speech therapist

  • Nutrition counselor

The primary concern is ensured surgical removal; secondary concerns deal with restoring function and cosmetic results. If the anatomy restricts ensured removal, medical oncologists and radiation oncologists must provide the most appropriate adjunctive therapy.

Maxillofacial prosthodontists can provide advice about the appliances available and about tissue requirements for support and retention. In addition, surgery mostly likely results in compromised oral function, which affects speech and nourishment. Rehabilitation and constant reinforcement may be important in restoring function.

Nutritional counseling is helpful. Loss of teeth and significant bony anatomy make eating difficult. Depending on the extent of surgery, dietary modifications may be necessary until obturators and dental appliances are fabricated and placed to restore function. Chewing and deglutition may be severely compromised, and aspiration may be possible. Retraining may be necessary to facilitate swallowing and to protect the swallowing reflex. Patients may have difficulty eating and gravitate toward soft diets. However, soft diets are cariogenic and often high in fat and calories.

The involved consultants should be aware of the recall schedule to assess patient progress and adaptation.


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