Identification of Mucosal Malignant Melanoma on The Root; A Rare Case

Case Report

J Dent App. 2015;2(4): 202-204.

Identification of Mucosal Malignant Melanoma on The Root; A Rare Case

Nihat Demirtas1*, Erol Senturk2, Hakki Oguz Kazancioglu1 and Emre Aytugar3

1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey

2Department of Otorhinolargeryngology Head and Neck Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

3Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey

*Corresponding author: Nihat Demirtas, Bezmialem Vakif University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery 34093-Istanbul,Turkey

Received: February 09, 2015; Accepted: March 11, 2015; Published: March 13, 2015;


Mucosal malignant melanoma of the head and neck regionis a very rare entity.It can occur in oral soft tissues such as gingival regions, buccal mucosa, tongue and floor of the mouth. In additionparanasal sinuses and sinonasal tract may be affected. In the literature, great mortality and morbidity rates were reported because of itsaggressive metastatic character.Thus, it is important to note that early diagnosisand treatment play a key rolein the management of these lesions.Here, we presenta case of mucosal malignant melanomathatdetectedin the sinonasal cavity following tooth extraction. The lesion was treated by surgical excision and radiotherapy. The patient is well without any symptoms or signs of recurrence one year after treatment. We aimed to report thisrare case of malignant melanomawith emphasis on its unusualpresentation.

Keywords: Malignant melanoma; Tooth extraction; Sinonasal cavity; Diagnosis


Malignant melanomawhich should be present with mucosal involvement is a serious cancer. It has great morbidity and mortality rates [1,7]. Primary mucosal malignant melanomas can occur in sinonasal and oral cavites and account for 1.3%–1.4% of all melanomas[2]. It was first reported in the English literature by Lincoln et al. [3].

The etiology of the mucosal malignant melanoma is not clear. However, many factors have been suggested as risk factors including tobacco and alcohol habits, nutritional deficiencies and infections [4]. On the other hand, C-kit gene mutations are reported in 21% of mucosal melanoma [5].

The frequency of malignant melanomas in the sinonasal cavity is approximately 1 in 500,000 to 1 in 1,000,000 people in the general population[6]. Diagnosis may be missed or delayed because of asymptomatic presentation in the early stages[7,8].Additionally, primary mucosal melanomas in the maxillary sinus and nasal cavityhave an aggressive character and poor prognosis due to complex anatomic location and rich vascularisation [9].

This paper aims to emphasize the importance ofearly identification and intervention in mucosal malignant melanoma of the sinonasal cavity.

Case Report

A 32-year-old woman was admittedto our faculty. Her chief complaint was chewing difficulty. The patient was normally healthy and taking no medications. Clinical examination revealed advanced stage periodontal disease, toothmobility and missing teeth. During a panoramic examination, progressive dental caries and bone resorption were identified in the interdental regions (Figure 1). After prosthetic treatment planning, it was determined thatmaxillary right lateral, second premolar and second molar teethhadto be extracteddue to intrabony defects and caries. The informed consent was given by the patient, and a posterior superior alveolar block and infiltrating anaesthesia of the hard and soft tissues were done to extract maxillary right second molar. After extraction, a black lesion was observed on the apical region of the root (Figure 2). Moreover, oro-antral communication occurred. We suspected a mucosal disease of the maxillary sinus and requested ahistopathological examination. Biopsy specimens were obtained from the maxillary sinus mucosa. According to the results of the histopathological examination, the lesion was diagnosed as mucosal malignant melanoma (Figure 3). The patient referred to otolaryngology examination, and large melanocytic lesions within the right nasal cavity and paranasal sinus weredetected. At this stage Cone Beam Computed Tomography (CBCT) scans were obtained to evaluate the growth pattern of the lesion. Focal perforations in buccal cortex and lateral nasal wall were observed in 3-dimensional reconstructed images (Figure 4a). Axial and cross section images also revealedthe involvement of maxillary sinus and nasal cavity (Figure 4b and 4c).