The Untold Tales of Laryngeal Melanosis

Only 43 patients with laryngeal melanosis have been reported to date. Concomitant malignancy and dysplasia of the upper aerodigestive tract, ranging from 26% to 50%, have been encountered with this condition. Given the above, we undertook this study to assess the burden of laryngeal melanosis diagnosed in a tertiary care center. This was a retrospective observational study done with a review of all patients with laryngeal biopsies received over the previous 5-year period (2017-2022), on encountering an index patient. A representative slide from each patient was stained with Masson Fontana and bleached with potassium permanganate, and immunohistochemistry was performed using S100 and HMB45 (PMEL), wherever feasible. Sixty-five patients with laryngeal biopsies reported were included in the study, and laryngeal melanosis was detected in 9 patients (14% prevalence) of the total laryngeal biopsies. Seven out of 9 patients were associated with neoplasm, 6 patients (67%) with concomitant squamous cell carcinoma, and 1 (11%) with moderate dysplasia. We add another 9 patients to the list of laryngeal melanosis, based on our extensive literature search, taking the total to 52. We observed instances where laryngeal melanosis co-occurred with malignancies of the upper aerodigestive tract. Identifying laryngeal melanosis during direct laryngoscopy can serve as a marker that encourages surgeons and pathologists to exercise prudence and ensure thorough investigation.