Clinical features

Oral melanomas are usually asymmetric

Fig. 4.56 Malignant melanoma. multiple or widespread areas of dark macular pigmentation affecting the palate. Irregular nodular areas are also seen.

with irregular outlines. They may be black, grey or purple to red, and rarely amelanotic. Typical lesions are composed of multiple or widespread areas of macular pigmentation with areas of nodular growth. Purely macular lesions may be seen but over 50% of lesions present as nodules or as a pigmented epulis. Ulceration is seen in about one third of cases and invasion of bone is common. Many reports document longstanding 'melanosis' before the onset of nodular lesions, with a history of up to 10 years. Oral lesions are usually advanced at presentation with up to 75% of patients having metastases to cervical lymph nodes, and 50% with distant metastases, usually to lung or liver {144,617,1085}.

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