Which clinical history and physical findings are characteristic of head and neck mucosal melanomas?

Updated: May 07, 2020
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Most patients with sinonasal mucosal melanoma present with unilateral nasal obstruction, epistaxis, or a combination of the two. Discharge, epiphora, facial pain, and swelling are more common in advanced cases.

The most prevalent clinical presentation of tumors within the oral cavity is a painless mass. Commonly, ulceration and bleeding can be present. Determining whether a mucosal melanoma is a primary or metastatic lesion is often extremely difficult, because cutaneous melanoma may metastasize widely, including to the mucous membranes. Patients with a history of cutaneous or ocular melanoma or nevi that have regressed should be considered to have metastatic melanoma rather than primary mucosal melanoma. [5]

The most important features in defining a primary lesion from a metastatic lesion are site of involvement, presence or absence of pigment, overlying mucosal ulceration, extension along salivary gland ducts, and vascular and perineural invasion.


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