Palatal Melanoma: Clinical Characteristics and Therapeutic Approaches (a case repport)

Introduction Oral cavity melanoma is a tumor with a high metastatic potential. Once diagnosed, a locoregional and distant staging is necessary. The therapeutic management of this tumor is difficult. Radical surgery with clear margins is the cornerstone of treatment. This therapeutic option is not always possible, due to anatomical and functional constraints. The use of lymph node dissection is still controversial, especially if there is no evidence of lymph node involvement. Other therapeutic modalities can be used, such as chemotherapy and radiotherapy, immunotherapy, and targeted therapy. Observation A 54-year-old patient presented with a multi-lobulated blue-black mass originating from the alveolar mucosa of the upper maxilla. This tumor extends posteriorly to invade the hard palate evolving for 14 months with the appearance of cervical lymphadenopathy. Biopsy performed and the diagnosis of nodular melanoma was made. Staging revealed pulmonary metastases. The patient received two courses of chemotherapy combining cisplatin-dacarbazine, followed by surgical excision with ipsilateral lymph node dissection. The margins of resection were clear with nodal metastases and capsular breach, indicating three sessions of radiotherapy. Discussion Melanoma of the oral cavity is a rare, aggressive malignant tumor arising from clonal proliferation of melanocytes. The pathophysiology remains unclear, and the tumor often remains asymptomatic for a long time, leading to delayed diagnosis and worsening prognosis. Diagnosis is based on histopathological examination of biopsy or surgical specimens and immunohistochemistry. Once diagnosed, staging with local, regional, and distant evaluation is necessary to determine the disease stage and choose the appropriate therapeutic strategy.