세포병리 월례집담회 KCP761 ( 가톨릭대학교 의정부성모병원 ) 제출자

병 력병 력 65 세 남자환자 왼쪽 아래턱에 부종으로 개인의원에서 2 주간 항생제 치료하였으나 증상 호전없이 부종증가로 내원 CT 소견상 왼쪽 턱밑샘 ( 악하선 ) 에 비균질 음영을 보이는 6x5x4cm 크 기 종괴가 팽창성 형태를 띄고 있으며, 경부 2 순위에서 3cm 크기의 비균질 음영을 보이는 림프절이 보임 종괴절제 및 경부림프절 청소술

6x5x4cm mass heterogeneous density Enlarged LN (3cm)

HMB45PanC K S100 Vimentin PanCK

Diagnosis Gingiva, biopsy; Malignant melanoma.

Ref; Primary Malignant Melanoma of the Oral Mucosa J Oral Maxillofac Surg 65: , 2007 Primary oral mucosal melanoma is rare and represents 0.2% to 8% of all melanomas and 0.5% of all oral malignancies. In the present study only 8 cases were seen over a 23-year period, thus also confirming the rarity of this lesion in the oral cavity. an average age of 56 years and slight male preponderance extremely rare in ages below 30 years. Primary Malignant Melanoma of the Oral Mucosa

Wide surgical excision managed to control the disease for an average of 7 years before local recurrence. Metastatic lymph nodes developed much later in the disease process, despite the large tumor size at presentation. Radical surgery is the treatment of choice for oral melanoma however, this could also be in combination with radiotherapy and chemotherapy or radiotherapy alone in inoperable tumors or in the Elderly. Elective neck dissection has also been advocated. Immunochemotherapy has been shown to be useful as an adjuvant to surgical resection. Ref; Primary Malignant Melanoma of the Oral Mucosa J Oral Maxillofac Surg 65: , 2007

Oral melanoma has a more aggressive course than cutaneous melanoma. All our patients presented with a pigmented mass, which was subsequently confirmed as melanoma by histopathologic examination. The lesions were deemed primary by way of thorough history and physical examination, which ruled out the possibility of occult melanotic lesions elsewhere in the body. On histologic examination, the presence of junctional activity, ulceration, and transmucosal migration are some of the features that favor diagnosis of a primary melanoma. Primary Malignant Melanoma of the Oral Mucosa Ref; Primary Malignant Melanoma of the Oral Mucosa J Oral Maxillofac Surg 65: , 2007

Median survival for all oral mucosal melanomas is slightly over 2 years from the time of diagnosis. This depends on whether there is lymph node involvement (18 months) or not (46 months). Increased tumor thickness, level, and the vertical growth phase of the tumor at diagnosis are also related to poor prognosis Primary Malignant Melanoma of the Oral Mucosa Ref; Primary Malignant Melanoma of the Oral Mucosa J Oral Maxillofac Surg 65: , 2007

Pigmented lesions on buccal aspect of right mandibular molar area Ref; Primary Gingival Malignant Melanoma. Report of 3 Cases J of periodontology jan 2000 vol.71

[F/U for 6months] post op. 1month RT & Chemotherapy PET CT ; LN metastasis Chemotherapy CVD (cisplatin, vinblastine and dacarbazine)