The recurrent primary malignant melanoma of the palatal mucosa - a case report

Background: Primary malignant melanoma (MM) of the oral mucosa is a rarity and only occurs in an amount of 1.5 to 2% of the total number of all melanomas. The clinical picture may be very heterogeneous. Confusion with other benign oral mucosal lesions or compromises to radical therapy can induce far-reaching consequences. Case report: A 42-year-old female presented with externally secured, histological diagnosis of MM of the palatal mucosa. Eight years earlier, a MM was been excised at the first time. Two recurrence-operations followed by 4 and 5 years. At first presentation in our center, a 1 x 1.5 cm ulcerated defect after biopsy alio loco could be found in the area of the hard palate. The further work-up revealed no evidence for regional or distant metastases. However, the single photon emission computed tomography showed tracer accumulation in projection onto the hard palate region of the lesion. Surgery comprised the complete removal of the hard palate with primary reconstruction of the defect by means of a fasciocutaneous forearm flap. Histologically, cells of MM could only be detected sporadically and without evidence for osseous invasion, corresponding to a stage I disease. Tumor-board recommended no adjuvant therapy. One year after treatment, the patient is disease-free and had no functional deficits concerning speaking, swallowing or eating. Conclusion: The tendency to recur and the aggressiveness of a mucosal MM make a radical surgical approach essential. Even larger defects can be reconstructed without or minimal functional deficits. Therefore, and in order to evaluate adjuvant therapy options, the treatment in correspondingly aligned oncological centers should be performed. Keywords: malignant melanoma, palatal mucosa, recurrence