What are the gross pathologic features 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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Gross appearance of the tumor is often variable, ranging from macular to ulcerated and nodular. Tumors arising in the nasopharynx are most commonly friable and polypoid in character. The clinical color of oral melanomas varies from black to gray to purple to red to white. Some lesions are uniform in color, whereas others exhibit marked variations. Grossly noticeable pigmentation occurs in approximately 75% of oral melanomas but in only 50% of sinonasal melanomas.

Mucosal melanosis has been reported to be frequently encountered adjacent to oral melanoma and may exist for a considerable period of time before diagnosis. In Japan, almost two thirds of oral melanomas are reported to be associated with melanosis; however, a preexisting pigmented lesion is not usually associated with mucosal melanomas in white patients. One suggestion is that melanosis represents the radial phase of the growth of the tumor and precedes the vertical component by years.

In contrast to cutaneous melanoma, the presentation of those involving head and neck mucosal surfaces is typically at a more aggressive vertical growth phase with invasion of the underlying submucosa. As a result of the advanced stage at discovery, most do not have an associated radial growth (superficial spreading) phase.

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