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Mucosal Melanoma - Facts and Information

  • Date: 2010/03/13
  • Thomas C. Weiss
  • Synopsis : Mucosal melanoma are lesions that may be blue to black in color with irregular borders.

Main Document

Mucosal melanoma are lesions that may be blue to black in color with irregular borders. Malignant melanoma, whether they are present on a person's skin or in their oral cavity, have the same cell of origin; the melanocyte.

Even though they have the same cell of origin, they do present with different clinical behavior, depending upon the location of the melanoma. Malignant melanoma commonly affects adults with an average age of fifty-five. On occasion they affect people under the age of thirty. A person's tongue is an unusual location for oral malignant melanoma.

Malignant melanoma of the skin was formerly associated with a poor prognosis, although that has changed significantly. The year 1950 found the five-year survival rate for skin malignant melanoma at fifty-percent; today that survival rate has reached ninety-percent. Mucosal melanoma; however, still has a poor survival rate of not higher than thirty-eight percent. Skin malignant melanoma, as with mucosal melanoma, occurs largely in the adult population in persons around fifty years of age, rarely affecting children.

People who have oral mucosal malignant melanoma find them to be largely, 'asymptomatic,' meaning that they do not experience any symptoms associated with the condition. Oral mucosal melanomas are an extremely malignant form of tumor, with a, 'chameleonic,' presentation, and a poor prognosis. Treatment of oral mucosal melanomas is highly-specialized, with factors that need to be seriously considered by the person's health care provider. Melanomas that arise from oral mucosa have a poor prognosis unless they are both discovered and treated early.

Fortunately, primary mucosal melanomas involving a person's head and neck are rare, occurring far less frequently than melanomas of the skin. Among melanomas of the neck and head region, oral mucosal melanomas are highly infrequent, accounting for a mere half of one-percent of all oral neoplasms. Oral mucosal melanomas are highly malignant tumors that have a tendency to, 'metastasize,' or spread to tissues more easily than other malignant tumors involving a person's oral cavity. Approximately one-third of people do not experience any symptoms whatsoever at the time they are diagnosed. Episodes of hemorrhage appear to be the top symptoms that people do end up experiencing.

Cutaneous malignant melanoma is the third most common skin epithelial malignancy, following basal cell carcinoma and squamous cell carcinoma, and is clearly the most aggressive. In America, greater than fifty-thousand people are diagnosed each year with around eight-thousand people dying from the disease every year. The disease has been increasing since the year 1960, although it has recently plateaud. The 1960's found approximately one in every six-hundred people expected to develop malignant melanoma during their lifetime, compared to one in one-hundred and seventy-one in the year 2001. Australia has the highest number of skin malignant melanomas; the number of people experiencing them there has doubled every year for a decade. The etiology of malignant melanoma and its rate of increase are complex. There are multiple factors that appear to play a role in the development of malignant melanoma, as well as their progression. The greatest factor is exposure to ultraviolet light, something that explains malignant melanoma on the skin, yet does not explain oral, nasal, or other forms of malignant melanoma that are not due to sun exposure.

There has been a suggestion made that the age of the person at the time of exposure is relevant and important. Another suggestion that has been made is that sunburns, particularly blistering sunburns during a person's childhood, increase the risk a person has of developing malignant melanoma during adulthood. A person's genetics play a significant role in malignant melanoma, especially in people who are born in families with a history of the disease. For example; people who have family members with a history of dysplastic mole syndrome, or people who have a first relative with malignant melanoma, are at greater risk of developing the disease. Approximately seventy-percent of cutaneous malignant melanomas occur in pre-existing pigmented nevus, which are common. Pigmented nevus present a one in a million chance of transforming into a malignant melanoma. While this does not mean there is a need to have them surgically removed, it does suggest that health care workers should be attentive to alterations in nevi, to include changes in their shape, size, or color. Health care workers should also look for any bleeding or ulceration of nevi, pain, inflammation, or a diameter change of greater than 7mm.

A person's oral mucosa are rarely affected by malignant melanoma. Because of this, the etiology of oral malignant melanoma is something that remains unclear. Tobacco use has been associated with oral mucosal malignant melanoma. A person's race is something else that seems to play a role. For example; seven and a half percent of all persons with oral melanomas are people of Japanese decent, while ten-percent are of Ugandan decent; one-percent of person's affected are Caucasians. Cutaneous malignant melanoma, on the other hand, is something that occurs at a far greater rate among the Caucasian population than in other populations, with a rate of one in eighty-three in whites compared to one in one-thousand, one-hundred and seventy-six in persons of color. Mucosal melanomas are very rare compared to cutaneous melanomas, constituting a mere one-percent of all malignant melanomas.

Criteria used in England to assess the clinical presentation of malignant melanoma include any bleeding or ulceration of a pigmented nevus. The lesion should be biopsied and then completely removed and submitted for microscopic examination. America follows the, 'ABCDE,' rule; Asymmetry, Borders, Color, Diameter, and Enlargement in relation to nevus involved. A pigmented lesion that is asymmetrical with irregular borders and uneven coloration that is larger than 6mm in diameter, that also continues to enlarge, is one that should be viewed with suspicion and biopsied promptly.

Eighty-percent of oral malignant melanomas affect the person's palate and maxillary gingival. Mandibular gingival may also be affected, although this is a rare occurrence. Cutaneous malignant melanomas occur largely on the interscapular area of a person's back, or the back of their legs. Around twenty-five percent occur in the person's neck and head area, to include their eyes, nose, face, and mouth. Should a malignant melanoma affect a person's mouth, the present as flat, multiple, graded, or with uneven coloration and with irregular borders. At times they may be ulcerated as well. Oral malignant melanoma are commonly asymptomatic and do not cause pain, growing in radial and vertical patterns. People affected by malignant melanoma have a prognosis that depends upon factors such as their location, age, and gender. Treatment may involve surgery, radiation, or chemotherapy.




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