Oral mucosal melanoma: clinicopathological analysis and narrative review of a case with heterogeneous clinical presentation

Fabiana da Silva de Oliveira; Paulo Sergio Pina; Jheinis Stefany Pascuineli Duarte; Suzana Cantanhede Orsini Machado; Norberto Nobuo Sugaya; Celso Augusto Lemos

doi:10.5327/2525-5711.459

Authors

Fabiana da Silva de Oliveira Universidade de São Paulo, School of Dentistry, Department of Stomatology – São Paulo (SP), Brazil. https://orcid.org/0009-0003-5324-2695
Paulo Sergio Pina Universidade de São Paulo, School of Dentistry, Department of Stomatology – São Paulo (SP), Brazil. https://orcid.org/0000-0001-8205-9935
Jheinis Stefany Pascuineli Duarte Universidade de São Paulo, School of Dentistry, Department of Stomatology – São Paulo (SP), Brazil. https://orcid.org/0009-0005-5737-8439
Suzana Cantanhede Orsini Machado Universidade de São Paulo, School of Dentistry, Department of Stomatology – São Paulo (SP), Brazil. https://orcid.org/0000-0002-9708-9608
Norberto Nobuo Sugaya Universidade de São Paulo, School of Dentistry, Department of Stomatology – São Paulo (SP), Brazil. https://orcid.org/0000-0003-4966-6295
Celso Augusto Lemos Universidade de São Paulo, School of Dentistry, Department of Stomatology – São Paulo (SP), Brazil. https://orcid.org/0000-0002-3372-6719

DOI:

https://doi.org/10.5327/2525-5711.459

Keywords:

Melanoma, Mouth Neoplasms, Gingiva, Mouth floor, Case reports

Abstract

Oral mucosal melanoma is a rare and aggressive malignant neoplasm, frequently associated with delayed diagnosis and unfavorable prognosis. This study aims to report a case of oral mucosal melanoma located at a non-palatal site, presenting as an extensive pigmented lesion affecting the lower gingiva and extending to the floor of the mouth, a topography less frequently described for this neoplasm, as well as to present a narrative review of the literature. An adult patient presented with a pigmented lesion in the lower gingival region extending to the floor of the mouth. The diagnosis was established through histopathological and immunohistochemical examination, confirming oral mucosal melanoma. The literature review addressed clinical, diagnostic, and prognostic aspects of oral mucosal melanoma, highlighting the influence of anatomical location and the biological particularities of this neoplasm in comparison with cutaneous melanoma. It is concluded that the recognition of atypical melanocytic lesions in less common sites of the oral cavity is essential for early diagnosis and appropriate clinical management of oral mucosal melanoma.

References

1. Sen S, Sen S, Kumari MG,Khan S, Singh S. Oral malignant melanoma: a case report. Prague Med Rep. 2021;122(3):222-7. https://doi.org/10.14712/23362936.2021.20

2. Bansal SP, Dhanawade SS, Arvandekar AS, Mehta V, Desai RS. Oral amelanotic melanoma: a systematic review of case reports and case series. Head Neck Pathol. 2022;16(2):513-24. https://doi.org/10.1007/s12105-021-01366-w

3. Haimowitz S, Cohen DA, Dhanda A, Barron K, Povolotskiy R, Roden D. Mucosal melanoma of the oral cavity: what is the role of elective neck dissection? Laryngoscope. 2023;133(2):317-26. https://doi.org/10.1002/lary.30152

4. Carvajal RD, Spencer SA, Lydiatt W. Mucosal melanoma: a clinically and biologically unique disease entity. J Natl Compr Canc Netw. 2012;10(3):345-56. https://doi.org/10.6004/jnccn.2012.0034

5. Clavero-Rovira L, Gómez-Tomás A, Bassas-Freixas P, Bodet D, Ferrer B, Hernández-Losa J, et al. Clinical management and prognostic implications of mucosal melanoma: a retrospective cohort study. Cancers. 2024;16(1):227. https://doi.org/10.3390/cancers16010227

6. Thuaire A, Nicot R, Boileau M, Raoul G, Descarpentries C, Mouawad F, et al. Oral mucosal melanoma: a systematic review. J Stomatol Oral Maxillofac Surg. 2022;123(5):e425-32. https://doi.org/10.1016/j.jormas.2022.02.002

7. Lourenço SV, Bologna SB, Colucci F, Festa Neto C, Montenegro FL, Nico MM. Oral mucosal melanoma of the mandibular gingiva: a case report. Cutis. 2010;86(2):89-93.

8. Arruda JA, Drumond VZ, Tenório JR, Abreu LG, Silva TA, Mesquita RA, et al. Oral melanoma in older adults: epidemiology, molecular landscape, and treatment strategies. Pigment Cell Melanoma Res. 2025;38(3):e70017. https://doi.org/10.1111/pcmr.70017

9. Podlińska K, Monist M, Sławińska M, Popowski W. Multifocal oral mucosal melanoma with an atypical clinical presentation. Dent J. 2025;13(9):432. https://doi.org/10.3390/dj13090432

10. Zito PM, Brizuela M, Mazzoni T. Oral melanoma. In: StatPearls. Treasure Island (FL): StatPearls; 2025.

11. Jiang C, Jain NP, Stewart CL. Amelanotic melanoma: Clinical presentation, diagnosis, and management. Clin Dermatol. 2025;43(1):10-5. https://doi.org/10.1016/j.clindermatol.2025.01.009

12. Kukde MM, Madurwar AU, Selokar DS, Noman O. A case report of oral malignant melanoma: a silent killer. Cureus. 2023;15(3):e36671. https://doi.org/10.7759/cureus.36671

13. Beaudoux O, Oudart JB, Riffaud L, Visseaux L, Marchal A, Lebre AS, et al. Mutational characteristics of primary mucosal melanoma: a systematic review. Mol Diagn Ther. 2022;26(2):189-202. https://doi.org/10.1007/s40291-021-00572-0

14. Saleem A, Narala S, Raghavan SS. Immunohistochemistry in melanocytic lesions: Updates with a practical review for pathologists. Semin Diagn Pathol. 2022;39(4):239-47. https://doi.org/10.1053/j.semdp.2021.12.003

15. Jasper P, Jungbauer WN, Poupore NS, Nguyen SA, Howell J, Neville BW, et al. Mucosal Melanoma in situ of the oral cavity: a case report and systematic review of the literature. Turk Arch Otorhinolaryngol. 2022;60(3):161-9. https://doi.org/10.4274/tao.2022.2022-7-5

16. Barata B, Freitas F, Vilares M, Caramês J. Oral mucosal melanoma: a systematic review of case reports and case series. J Oral Maxillofac Surg Med Pathol. 2024;36(3):388-95. https://doi.org/10.1016/j.ajoms.2023.09.002

17. Chae YS, Lee JY, Lee JW, Park JY, Kim SM, Lee JH. Survival of oral mucosal melanoma according to treatment, tumour resection margin, and metastases. Br J Oral Maxillofac Surg. 2020;58(9):1097-102. https://doi.org/10.1016/j.bjoms.2020.05.028

18. Tarnawski J, Wojciechowska B, Polcyn A, Garbacewicz Ł, Drogoszewska B, Michcik A. Mucosal melanoma of the oral cavity: prognostic factors influencing patient survival outcomes. J Clin Med. 2025;14(19):6863. https://doi.org/10.3390/jcm14196863

19. Song H, Wu Y, Ren G, Guo W, Wang L. Prognostic factors of oral mucosal melanoma: histopathological analysis in a retrospective cohort of 82 cases. Histopathology. 2015;67(4):548-56. https://doi.org/10.1111/his.12692

20. Broit N, Johansson PA, Rodgers CB, Walpole ST, Newell F, Hayward NK, et al. Meta-analysis and systematic review of the genomics of mucosal melanoma. Mol Cancer Res. 2021;19(6):991-1004. https://doi.org/10.1158/1541-7786.MCR-20-0839

21. Nassar KW, Tan AC. The mutational landscape of mucosal melanoma. Semin Cancer Biol. 2020;61:139-48. https://doi.org/10.1016/j.semcancer.2019.09.013

22. Lyu J, Wu Y, Li C, Wang R, Song H, Ren G, et al. Mutation scanning of BRAF, NRAS, KIT, and GNAQ/GNA11 in oral mucosal melanoma: a study of 57 cases. J Oral Pathol Med. 2016;45(4):295-301. https://doi.org/10.1111/jop.12358

23. Shan Z, Liu F. Advances in immunotherapy for mucosal melanoma: harnessing immune checkpoint inhibitors for improved treatment outcomes. Front Immunol. 2024;15:1441410. https://doi.org/10.3389/fimmu.2024.1441410

24. Sebastian S, Yuwanati M, Ramani P. Prognostic predictors of oral mucosal melanoma-a systematic review and meta-analysis. Oral Dis. 2025;32(2):350-8. https://doi.org/10.1111/odi.70105

25. Adisa AO, Olawole WO, Sigbeku OF. Oral amelanotic melanoma. Ann Ib Postgrad Med. 2012;10(1):6-8.

26. Cooper H, Farsi M, Miller R. A rare case of oral mucosal amelanotic melanoma in a 77-year-old immunocompromised man. J Clin Aesthet Dermatol. 2021;14(1):27-9.

27. Singh D, Pandey P, Singh MK, Kudva S. Prevalence of malignant melanoma in anatomical sites of the oral cavity: A meta-analysis. J Oral Maxillofac Pathol. 2019;23(1):129-35. https://doi.org/10.4103/jomfp.JOMFP_236_18

28. Jou A, Miranda FV, Oliveira MG, Martins MD, Rados PV, S Filho M. Oral desmoplastic melanoma mimicking inflammatory hyperplasia. Gerodontology. 2012;29(2):e1163-7. https://doi.org/10.1111/j.1741-2358.2011.00482.x

29. Rosu OA, Tolea MI, Parosanu AI, Stanciu MI, Cotan HT, Nitipir C. Challenges in the diagnosis and treatment of oral amelanotic malignant melanoma: a case report. Cureus. 2024;16(4):e57875. https://doi.org/10.7759/cureus.57875

30. Mahesh KP, Krishna A, Shivamallu C, Sharath N, Appinakatte R. Oral melanomas: clinical insights and therapeutic perspectives. In: Aghaei S, editor. Melanoma: recent advances, new perspectives and applications. London: IntechOpen; 2025. https://doi.org/10.5772/intechopen.1012584

31. Sharma P, Wadhwan V, Tyagi S, Sharma R. Malignant melanoma of the oral cavity: an aggressive and rare entity. Indian J Otolaryngol Head Neck Surg. 2024;76(5):4842-5. https://doi.org/10.1007/s12070-024-04899-y

32. Abati S, Sandri GF, Finotello L, Polizzi E. Differential diagnosis of pigmented lesions in the oral mucosa: a clinical based overview and narrative review. Cancers. 2024;16(13):2487. https://doi.org/10.3390/cancers16132487

33. Moshe M, Levi A, Ad-El D, Ben-Amitai D, Mimouni D, Didkovsky E, et al. Malignant melanoma clinically mimicking pyogenic granuloma: comparison of clinical evaluation and histopathology. Melanoma Res. 2018;28(4):363-7. https://doi.org/10.1097/CMR.0000000000000451

34. Aziz Z, Aboulouidad S, Bouihi ME, Hattab NM, Chehbouni M, Raji A. Oral amelanotic malignant melanoma: a case report. Pan Afr Med J. 2020;37:350. https://doi.org/10.11604/pamj.2020.37.350.27330

35. Nenclares P, Ap Dafydd D, Bagwan I, Begg D, Kerawala C, King E, et al. Head and neck mucosal melanoma: The United Kingdom national guidelines. Eur J Cancer. 2020;138:11-8. https://doi.org/10.1016/j.ejca.2020.07.017