Fast Five Quiz: Skin Cancer

William James, MD

Disclosures

January 04, 2019

Mucosal melanoma is a rare form of melanoma that accounts for approximately 1%-4% of cases of head and neck melanomas. Most of these tumors (55%) arise in the nasal cavity, followed by the oral cavity (40%). Although the growth patterns of mucosal melanoma tend to mirror the nodular pattern of their cutaneous counterparts, they differ in that tumoral thickness is not well correlated with the prognosis. Although most patients present with clinically localized disease, over 50% experience local recurrence after treatment. Prognosis is dismal, regardless of the thickness of the primary lesion. In the literature, mean 5-year survival rates range from 0%-44%.

The three main types of cutaneous malignant melanoma on the head and neck are superficial spreading, lentigo maligna, and nodular lesions. Other, more rare, subtypes include desmoplastic and mucosal lesions. Superficial spreading melanoma accounts for approximately half of all head and neck melanomas. Nodular melanomas are aggressive lesions that have only a vertical growth phase. These lesions make up 15%-30% of head and neck melanomas.

Approximately 20% of head and neck melanomas are of the LM type. These typically are flat melanomas with a long radial growth phase. Lentigo maligna are regarded as the least invasive form of melanoma.

DMs are a rare subtype of melanoma. Most of them are found within the head and neck region. The clinical presentation of desmoplastic melanomas is unique, and these tumors do not generally adhere to the ABCDE criteria that typify more traditional cutaneous lesions. They are often found in conjunction with LM lesions. DM tumors tend to be locally aggressive and highly infiltrative. Consequently, they are frequently associated with involvement of the cranial nerves and skull base. Approximately half of these lesions recur.

For more information on melanoma types, read here.

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