Oral malignant melanoma (OMM) is a rare but highly aggressive malignancy that develops in the mucosal lining of the oral cavity. Of all primary melanoma cases, those arising from the oral cavity are extremely uncommon, and among these, involvement of the mandible as the primary site is even rarer. A 42-year-old woman presented with a bluish pigmented lesion over the left mandibular gingiva, associated with mild pain and intermittent bleeding from the lesion. Clinical examination revealed a melanocytic lesion involving the gingiva. Imaging studies, including contrast-enhanced computed tomography (CECT) and positron emission tomography (PET), revealed a metabolically active lesion with bone involvement. A biopsy confirmed the diagnosis of oral malignant melanoma. The patient underwent wide local excision with segmental mandibulectomy and elective neck dissection with pectoralis major myocutaneous flap reconstruction and adjuvant radiotherapy. The postoperative period was satisfactory. The patient remains disease-free at 18-month follow-up, with no signs of recurrence. OMM, though rare, requires high clinical suspicion due to its resemblance to other benign lesions. Early detection and aggressive surgical resection remain the key to a favorable outcome. Due to its rarity, it is not uncommon to mistake this oral melanotic lesion for other benign oral lesions such as dental amalgam, drug-induced pigmentation, Peutz-Jeghers syndrome, and even Addison's disease. The prognosis remains poor due to its aggressive nature and tendency for early metastasis. This case emphasizes the importance of timely diagnosis and multidisciplinary treatment for this rare malignancy.
Soni et al. (Tue,) studied this question.