Mucosal melanomas constitute a subtype of melanoma with less effective treatments than cutaneous melanomas. We present a case of oral mucosal melanoma that recurred despite multiple resections and adjuvant temozolomide. Treatment with topical imiquimod combined with pembrolizumab achieved remission. A 56-year-old woman presented with a pigmented mass on her left anterior hard palate. Biopsy revealed malignant melanoma. The patient had resection with neck dissection with 3 months of adjuvant temozolomide due to positive margins. Malignant melanoma involving the hard palate recurred 1 year later requiring additional resection. Two years later, two additional pigmented lesions were found; further resections were deferred due to expected morbidity. Following 6 weeks of topical imiquimod treatment, the lesions shrunk significantly. Adjuvant pembrolizumab was added and complete histopathologic remission was observed in 6 months. The patient remained in remission for 4 years before new melanoma in situ was diagnosed, requiring five additional months of imiquimod. As of April 2021, there is no clinical evidence of melanoma. There are limited reports of oral melanoma treated with topical imiquimod. Here, imiquimod administered in combination with pembrolizumab achieved complete pathologic response.

• case reports
• immunomodulation
• immunotherapy
• melanoma

Primary malignant melanoma of the oral cavity is a rare tumor in clinical practice. Extensive malignant melanomas are still very rare in the literature. Patients with malignant melanoma of oral cavity are often diagnosed at the advanced stage of the disease due to their painless and nonspecific radiological findings. Histopathology is the gold standard for the final diagnosis and staging of the tumor. Surgery followed by radiotherapy is the standard treatment offered to patients with malignant melanoma. Here we present a rare case of extensive malignant melanoma of oral cavity which was successfully managed by surgical excision followed by adjuvant radiotherapy.

• Malignant melanoma
• Management
• Oral cavity

Melanoma is clinicopathologically a heterogeneous disease with rising incidence. Metastatic disease is associated with poor outcomes, and immunotherapy was first approved in 2011 for its treatment. In our analysis of a large national database, we describe the epidemiology, clinical presentation, and survival outcomes of cutaneous, ocular, and mucosal melanoma in recent years. Metastatic cutaneous melanoma had better survival than both metastatic ocular and mucosal melanoma. We found higher odds of metastatic disease at diagnosis amongst African Americans compared to Caucasians. Additionally, for metastatic cases, we noted 25% lower mortality in those treated at an academic facility compared to community cancer programs and a 20% real-world survival benefit following approval of immunotherapy. This real-world survival benefit was definitely seen in Caucasians and those with cutaneous or mucosal melanoma. Further investigation is needed to confirm this benefit in African Americans and ocular melanoma.

Background: The incidence of invasive melanoma is rising, and approval for the first immune checkpoint inhibitor (ICI) to treat metastatic melanoma occurred in 2011. We aim to describe the epidemiology and outcomes in recent years, sociodemographic factors associated with the presence of metastasis at diagnosis, and the real-world impact of ICI approval on survival based on melanoma subtype and race. Methods: This is a retrospective analysis of the National Cancer Database (NCDB) from the years 2004–2015. The primary outcome was the overall survival of metastatic melanoma by subtype. Secondary outcomes included sociodemographic factors associated with the presence of metastasis at diagnosis and the impact of treatment facility type and ICI approval on the survival of metastatic melanoma. Results: Of the 419,773 invasive melanoma cases, 93.80% were cutaneous, and 4.92% were metastatic at presentation. The odds of presenting with metastatic disease were higher in African Americans (AA) compared to Caucasians (OR 2.37; 95% CI 2.11–2.66, p < 0.001). Treatment of metastatic melanoma at an academic/research facility was associated with lower mortality versus community cancer programs (OR 0.75, 95 % CI 0.69–0.81, p-value < 0.001). Improvement in survival of metastatic melanoma was noted for Caucasians after the introduction of ICI (adjusted HR 0.80, 95% CI 0.78–0.83, p < 0.001); however, this was not statistically significant for AA (adjusted HR 0.80, 95% CI 0.62–1.02, p-value = 0.073) or ocular cases (HR 1.03, 95% CI 0.81–1.31, p-value = 0.797). Conclusion: Real-world data suggest a 20% improvement in survival of metastatic melanoma since the introduction of ICI. The disproportionately high odds of metastatic disease at presentation in AA patients with melanoma suggest the need for a better understanding of the disease and improvement in care delivery.

• epidemiology
• healthcare disparities
• immune checkpoint inhibitor
• immunotherapy
• melanoma
• real-world data

Primary Oral malignant melanoma is a rare tumor with an indigent prognosis. This is a case report of 47-year-old Sudanese female diagnosed as Oral malignant melanoma of the mandible with an unusual pattern of growth and clinical presentation. Furthermore, a possibility of intraosseous origin is suggested.

• Sudan
• epithelial neoplasm
• oral malignant melanoma
• unusual presentation

Head and neck mucosal melanoma (HNMM) is a rare type of malignant tumor that frequently exhibits postoperative recurrence and distant metastasis. Many clinicians administer postoperative adjuvant radiotherapy to improve patient prognosis and enhance quality of life; however, the effects of this treatment remain controversial. Therefore, in this study, a meta-analysis was performed to evaluate the practical value of postoperative adjuvant radiotherapy for head and neck mucosal melanoma.

Articles in the PubMed, MEDLINE, Cochrane Library, Web of Science and EMBASE databases were systematically retrieved. Analyses were conducted to compare the impact of treatments involving postoperative radiotherapy with treatments entailing surgery alone on patient overall survival time, local recurrence and distant metastasis. The hazard ratio (HR) was used to evaluate the time-to-event data employing RevMan version 5.2 and Stata/SE version 13.0 software according to the principles specified for systematic reviews of interventions in the Cochrane handbook.

Twelve cohort studies involving 1593 patients satisfied the desired conditions. In comparing surgery alone with postoperative radiotherapy, there was no significant difference regarding a decrease in the death risk in HNMM patients (HR, 1.07; 95 % CI, 0.95–1.2; p = 0.903; low heterogeneity, I² = 0); this was also the case for sinonasal melanoma after subgroup meta-analysis (HR, 1.04; 95 % CI, 0.8–1.36; p = 0.983; low heterogeneity, I² = 0 %). A sensitivity analysis and subgroup meta-analysis showed that disease progression was the main source of the instability in the results. Surgery combined with postoperative radiotherapy reduced the risk of local recurrence (HR, 0.51; 95 % CI, 0.35–0.76; p = 0.155) but did not reduce the risk of distant metastasis (HR, 2.26; 95 % CI, 1.01–5.05; p = 0.006).

This study demonstrated that for HNMM patients surgery is recommended if indicated, and surgery combined with postoperative radiotherapy is also recommended for dramatically improved local control of the tumor bed. For patients not suitable for surgical treatment, radiotherapy is still advised. To control distant metastasis and finally lower the risk of death, immunological therapy is another potential option whose therapeutic effect needs to be proved with more data from clinical trials.

Primary mucosal melanomas (MM) of the head and neck region constitute 0.5-2% of all malignant melanomas. The rynopharynx is a region that is less often involved by malignant melanomas. Because most of mucosal melanotic lesions are painless in their early stages, the diagnosis is unfortunately often delayed until symptoms resulting from ulceration, growth, and/or bleeding are noted. Here, we document the rare case of a malignant rynopharynx melanoma of a 43 year old woman. Its treatment and the pertinent literature are discussed. No complication was recorded in the post-operative period and no further surgery was performed. The follow up showed no recurrence in the same position and with the same characteristics, even after six years. Mucosal melanomas are aggressive tumours and the prognosis in these patients is poor. Clinicians must use treatment strategies that provide functional benefit, so as to maintain quality of life without excessive toxicity.

• Mucosal malignant melanoma
• rynopharynx
• surgical management

Primary mucosal melanoma of the paranasal sinuses is a rare tumor of the head and neck which can be a devastating disease. Cancers arising in the sinonasal cavity are extremely rare, with a poor survival rate. There is inherent difficulty in diagnosing these lesions due to their complex anatomic locations and symptoms which are often confused with more common benign processes. The primary treatment of this rare disease process is resection, except in advanced stages where surgical resection is not an option. Diagnostic accuracy in consideration of size, location, and presence of metastatic disease of these malignant tumors tailors individual patients to different management in order to achieve the longest possible survival.

• Chronic epistaxis
• Mucosal melanoma
• Paranasal melanoma
• Sinonasal cancer

• Aged
• Aged, 80 and over
• Female
• Genital Neoplasms, Female
• Head and Neck Neoplasms
• Humans
• Male
• Melanoma/diagnosis
• Melanoma/therapy
• Middle Aged
• Mucous Membrane/pathology
• Neoplasm Staging
• Prognosis
• Rectal Neoplasms
• Skin Neoplasms/diagnosis
• Skin Neoplasms/therapy

We performed multicenter study to define clinical characteristics of noncutaneous melanomas and to establish prognostic factors patients who received curative resection.

Of the 141 patients who were diagnosed of non-cutaneous melanoma at 4 institutions in Korea between June 1992 and May 2005, 129 (91.5%) satisfied the selection criteria.

Of the 129 noncutaneous melanoma patients, 14 patients had ocular melanoma and 115 patients had mucosal melanoma. For mucosal melanoma, anorectum was the most common anatomic site (n = 39, 30.2%) which was followed by nasal cavity (n = 30, 23.3%), genitourinary (n = 21, 16.3%), oral cavity (n = 14, 10.9%), upper gastrointestinal tract (n = 6, 4.7%) and maxillary sinus (n = 5, 3.9%) in the order of frequency. With the median 64.5 (range 4.3-213.0) months follow-up, the median overall survival were 24.4 months (95% CI 13.2-35.5) for all patients, and 34.6 (95% CI 24.5-44.7) months for curatively resected mucosal melanoma patients. Adverse prognostic factors of survival for 87 curatively resected mucosal melanoma patients were complete resection (R1 resection margin), and age > 50 years. For 14 ocular melanoma, Survival outcome was much better than mucosal melanoma with 73.3% of 2 year OS and 51.2 months of median OS (P = .04).

Prognosis differed according to primary sites of noncutaneous melanoma. Based on our study, noncutaneous melanoma patients should be treated differently to improve survival outcome.

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Melanoma/mortality
• Melanoma/therapy
• Middle Aged
• Nasal Mucosa/pathology
• Nose Neoplasms/mortality
• Nose Neoplasms/therapy
• Paranasal Sinus Neoplasms/mortality
• Paranasal Sinus Neoplasms/therapy
• Retrospective Studies
• Survival Rate
• Treatment Failure

• Anemia/etiology
• Female
• Humans
• Jejunal Neoplasms/diagnostic imaging
• Jejunal Neoplasms/pathology
• Melanoma/diagnostic imaging
• Melanoma/pathology
• Middle Aged
• Tomography, X-Ray Computed
• Ultrasonography
• Weight Loss

• Appendiceal Neoplasms/pathology
• Appendiceal Neoplasms/secondary
• Biopsy
• Humans
• Male
• Melanoma/pathology
• Melanoma/surgery
• Melanoma/therapy
• Middle Aged
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Stomach Neoplasms/therapy

• Abdominal Pain/etiology
• Diagnosis, Differential
• Fatal Outcome
• Gastrectomy
• Humans
• Lymph Node Excision
• Lymph Nodes/pathology
• Male
• Melanoma/complications
• Melanoma/diagnosis
• Melanoma/surgery
• Middle Aged
• Pyloric Antrum/pathology
• Pyloric Antrum/surgery
• Stomach Neoplasms/complications
• Stomach Neoplasms/diagnosis
• Stomach Ulcer/diagnosis
• Stomach Ulcer/etiology

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols
• Chemotherapy, Adjuvant
• Cisplatin/administration & dosage
• Dacarbazine/administration & dosage
• Fatal Outcome
• Female
• Humans
• Immunotherapy
• Male
• Melanoma/drug therapy
• Melanoma/radiotherapy
• Melanoma/surgery
• Middle Aged
• Oropharyngeal Neoplasms/drug therapy
• Oropharyngeal Neoplasms/radiotherapy
• Oropharyngeal Neoplasms/surgery
• Radiotherapy, Adjuvant
• Vincristine/administration & dosage

• Combined Modality Therapy
• Diagnosis, Differential
• Female
• Genital Neoplasms, Female/diagnosis
• Genital Neoplasms, Female/therapy
• Head and Neck Neoplasms/diagnosis
• Head and Neck Neoplasms/therapy
• Humans
• Lymphatic Metastasis
• Male
• Melanoma/diagnosis
• Melanoma/therapy
• Mucous Membrane
• Neoplasm Staging
• Rectal Neoplasms/diagnosis
• Rectal Neoplasms/therapy
• Skin Neoplasms/diagnosis
• Skin Neoplasms/therapy
• Survival Analysis
• Treatment Outcome

• Humans
• Male
• Melanoma/complications
• Melanoma/diagnosis
• Middle Aged
• Stomach Neoplasms/complications
• Stomach Neoplasms/diagnosis
• Stomach Ulcer/etiology

• Anus Neoplasms/diagnosis
• Anus Neoplasms/epidemiology
• Female
• Humans
• Male
• Melanoma/diagnosis
• Melanoma/epidemiology
• Middle Aged
• Mouth Neoplasms/diagnosis
• Mouth Neoplasms/epidemiology
• Nose Neoplasms/diagnosis
• Nose Neoplasms/epidemiology
• Penile Neoplasms/diagnosis
• Penile Neoplasms/epidemiology
• Prognosis
• Rectal Neoplasms/diagnosis
• Rectal Neoplasms/epidemiology
• Retrospective Studies
• Urethral Neoplasms/diagnosis
• Urethral Neoplasms/epidemiology
• Vaginal Neoplasms/diagnosis
• Vaginal Neoplasms/epidemiology
• Vulvar Neoplasms/diagnosis
• Vulvar Neoplasms/epidemiology

• Adult
• Age Distribution
• Age Factors
• Aged
• Aged, 80 and over
• Female
• Genital Neoplasms, Female/pathology
• Genital Neoplasms, Female/surgery
• Genital Neoplasms, Male/pathology
• Genital Neoplasms, Male/surgery
• Head and Neck Neoplasms/pathology
• Head and Neck Neoplasms/surgery
• Humans
• Male
• Medical Records
• Melanoma/pathology
• Melanoma/surgery
• Middle Aged
• Mucous Membrane
• Multivariate Analysis
• Neoplasm Recurrence, Local
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Retrospective Studies
• Sex Factors
• Survival Analysis

• Adult
• Bone Transplantation/methods
• Cryotherapy
• Electrocoagulation
• Female
• Follow-Up Studies
• Humans
• Laser Therapy
• Melanoma/surgery
• Mouth Mucosa/transplantation
• Neoplasm Recurrence, Local/surgery
• Palatal Neoplasms/surgery
• Surgical Flaps/methods
• Tissue Preservation
• Transplantation, Autologous

• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Combined Modality Therapy
• Female
• Gingival Neoplasms/mortality
• Gingival Neoplasms/pathology
• Gingival Neoplasms/radiotherapy
• Humans
• Japan/epidemiology
• Male
• Maxillary Neoplasms/mortality
• Maxillary Neoplasms/pathology
• Maxillary Neoplasms/radiotherapy
• Melanoma/classification
• Melanoma/mortality
• Melanoma/pathology
• Melanoma/radiotherapy
• Melanoma, Amelanotic/mortality
• Melanoma, Amelanotic/pathology
• Melanoma, Amelanotic/radiotherapy
• Middle Aged
• Mouth Neoplasms/mortality
• Mouth Neoplasms/pathology
• Mouth Neoplasms/radiotherapy
• Palatal Neoplasms/mortality
• Palatal Neoplasms/pathology
• Palatal Neoplasms/radiotherapy
• Sex Distribution
• Survival Analysis
• Survival Rate
• Treatment Outcome

• Adult
• Aged
• Aged, 80 and over
• Anus Neoplasms/mortality
• Anus Neoplasms/pathology
• Anus Neoplasms/surgery
• Female
• Humans
• Lymphatic Metastasis
• Male
• Melanoma/mortality
• Melanoma/pathology
• Melanoma/surgery
• Middle Aged
• Neoplasm Recurrence, Local/mortality
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/surgery
• Ohio/epidemiology
• Prognosis
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Retrospective Studies
• Survivors
• Time Factors

• Adult
• Cell Transformation, Neoplastic/pathology
• Gingival Diseases/pathology
• Gingival Neoplasms/pathology
• Gingival Neoplasms/surgery
• Humans
• Male
• Melanoma/pathology
• Melanosis/pathology

• Actuarial Analysis
• Adult
• Aged
• Aged, 80 and over
• Anus Neoplasms/mortality
• Anus Neoplasms/surgery
• Female
• Genital Neoplasms, Female/mortality
• Genital Neoplasms, Female/surgery
• Head and Neck Neoplasms/mortality
• Head and Neck Neoplasms/surgery
• Humans
• Male
• Melanoma/mortality
• Melanoma/surgery
• Middle Aged
• Mucous Membrane
• Prognosis

• Adult
• Aged
• Female
• Humans
• Melanoma/mortality
• Melanoma/pathology
• Melanoma/surgery
• Methods
• Middle Aged
• Neoplasm Recurrence, Local
• Vaginal Neoplasms/mortality
• Vaginal Neoplasms/pathology
• Vaginal Neoplasms/surgery
• Vulvar Neoplasms/mortality
• Vulvar Neoplasms/pathology
• Vulvar Neoplasms/surgery