Intraoral malignant melanoma
A 52-year-old female reported to the Out Patient Department, Drs. Sudha and Nageswarao Siddhartha Institute of Dental Sciences, Gannavaram, India, with a complaint of black discolouration in the upper gums in relation to the front teeth since 6 months. The patient gave a history of extraction of lower posterior teeth 5 yrs previously and past medical history was non-contributory.\nOn intraoral examination, a diffuse, sessile and asymptomatic swelling, with a smooth surface and of black colour was observed on the maxillary gingiva of anterior teeth involving both the labial as well as palatal side. On the right side of the maxilla the lesion was elevated and a well-defined blackish-brown colour discolouration present on right buccal and lingual mucosa [Figures and ].\nOn palpation the left submandibular lymph node was palpable and approximately 2 × 2 cm, non-tender, firm, which was fixed to the underlying tissues. Based on clinical appearance pigmented lesions like melanoacanthoma, nevus and melanoma were considered under differential diagnosis made. Blood investigations and radiographic features did not reveal any significant findings. Incisional biopsy of the lesion was performed and sent for histopathological examination.\nHaematoxylin and eosin-stained sections showed invasion of the connective tissue stroma by sheets and islands of pleomorphic epithelioid, spindle cell atypical melanocytes containing brownish to black pigment in the cytoplasm. The lesion was diagnosed as melanoma [Figures and ]. Further this was confirmed immunohistochemically by using HMB-45, which showed strong positivity of the tumour cells [].