What is the prognosis 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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Answer

Answer

As expected, the best prognosis is achieved with early recognition and complete excision, before significant invasion and metastasis have occurred. Oral melanoma is often overlooked or clinically misinterpreted as a benign pigmented process until it is well advanced. Radial and vertical extension is common at the time of diagnosis. The anatomic complexity and lymphatic drainage of the region dictate the need for aggressive surgical procedures.

The relative rarity of mucosal melanomas has dictated that tumor staging be based on the broader experience with cutaneous melanoma. Oral melanomas seem uniformly more aggressive and spread and metastasize more rapidly than other oral cancers or cutaneous melanomas. Early recognition, diagnosis, and treatment, that being assured surgical removal, greatly improves the prognosis.

In a large study (1074 mucosal melanomas), when the lymph node status was known, 30% of patients with mucosal melanomas had positive nodes. When lymph node metastasis occurs, the prognosis worsens precipitously. For example, the 5-year survival rate in patients with positive nodes is 16.4% as opposed to 38.7% in patients with negative nodes.

The prognosis for patients with oral malignant melanoma is poor, with the 5-year survival rate at 10-25%. Early recognition and treatment (surgical ablation) greatly improves the prognosis. As a result of the absence of corresponding histologic landmarks in the oral mucosa (ie, papillary and reticular dermis), Clark levels of cutaneous melanoma are not applicable to those of the oral cavity. However, tumor thickness or volume may be a reliable prognostic indicator.

Late discovery and diagnosis often indicate the existence of an extensive tumor with metastasis. After surgical ablation, recurrence and metastasis are frequent events, and most patients die of the disease in 2 years. A review of the literature indicates that the 5-year survival rate within a broad range of 4.5-48%, but a large cluster occurs at 10-25%.

Other prognostically significant variables include the degree of pigmentation and cell type, with a nonepithelioid cell type and strong pigmentation more favorable morphology, associated with improved survival. [23]

The best option for survival is the prevention of metastasis by surgical excision of any recurrent tumor. Eneroth and Lundberg stated that patients are not cured of oral melanoma and that the risk of death always exists. [24] Long periods of remission may be punctuated by sudden and silent recurrence.


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