From Malaise to Oral Pain: A Case Report on Oral Mucosal Melanoma.

Background: Oral melanoma is a rare form of melanoma that typically presents as a black-brown macule or nodule with variable pigmentation and occasional depigmented areas. Oral melanoma typically affects the maxillary gingiva, palate, and retromolar trigone, and tends to be aggressive with high propensity for distant spread and poor prognosis. We report a patient with metastatic visceral melanoma who, upon presentation for dental care, was found to also have advanced gingival melanoma with bone involvement. This may support the oral cavity as the primary site and represents a missed opportunity for early diagnosis. Case Description: A 61-year-old male presented to the emergency department with 20 pound weight loss and groin pain. Imaging work-up demonstrated liver masses, retroperitoneal lymphadenopathy, and lung nodules suspicious for metastatic disease. He returned to the emergency department 3 weeks later with a toothache and was instructed to follow up in the dental clinic in the hospital for tooth extractions. At this visit, discoloration of the gingiva was noted in the anterior maxilla (Teeth #6-9), and a biopsy confirmed the likely primary malignant site: oral melanoma. Practical Implications: This case highlights the importance of detecting melanoma in the oral cavity. Although rare, oral melanoma has a low five-year survival rate, and dentists must conduct a thorough head and neck exam with proper referral and follow up for any suspicious lesions.