Oral desmoplastic melanoma with nodular component: A rare and aggressive neoplasm

Malignant melanomas are uncommon entities in the oral cavity. In the United States, mucosal malignant melanomas constitute less than or equal to 2 percent of cases. They differ from cutaneous melanomas, heterogeneous and rare malignancies which are more aggressive and have poor prognoses. Involvement of oral mucous membrane is uncommon and accounts for only 0.2 to 0.8 % of all melanomas. They are rare tumor that arises from the epithelial cells due to malignant transformation of melanocytes or its precursors. They are considered as exceptionally invasive neoplasms with high metastatic and mortality rates. Men are affected three times more frequently than women and 80% of the oral lesions occur in maxilla. They remain asymptomatic for a longer period of time. Early detection of the tumor and the introduction of new immunotherapeutic drugs in recent years have significantly improved five year survival rates of patients with melanoma. The clinical appearance of the tumor at early stages mimics a variety of other oral conditions which makes the diagnosis challenging. Delayed diagnosis at an advanced stage contributes to poor prognosis and high mortality rates. The diagnosis is challenging due to its unique, asymptomatic character and a variety of benign lesions which mimic malignant melanoma. Hence, most of these tumors are diagnosed at a later stage, which are associated with high likelihood of metastasis and high mortality rates. In this case report, we have detailed a case of oral desmoplastic melanoma with nodular component.

Dr. Anu Jose practices as a Facio-Maxillary Surgeon at The University Hospital of the West Indies, Kingston, Jamaica, and as an Oral and Maxillofacial Oncologist at FOSA Surgical Associates. Dr. Jose's academic journey commenced with her comprehensive post-graduate training in OMFS at PMNM Dental College and Hospital This rigorous residency provided extensive exposure to the full spectrum of oral and maxillofacial pathology, establishing the foundation for her subsequent subspecialization. Her Fellowship in Oral Oncology from the distinguished SGM Cancer Center has equipped her with unparalleled expertise in managing complex head and neck malignancies. Her pursuit of advanced fellowship training in oral oncology reflects her dedication to mastering the most complex aspects of head and neck cancer management, positioning her among the elite practitioners in this highly specialized field.

Dr. Jose's intellectual contributions to the field are substantiated by her impressive portfolio of over 28 peer-reviewed publications in prestigious journals indexed within PubMed and Scopus databases. Her research addresses critical areas of clinical relevance, with particular emphasis on oncological outcomes, reconstructive innovations, and evidence-based surgical protocols. Dr. Jose's commitment to advancing the field through innovation is exemplified by her recent patent achievement: "A Scale for Evaluation of Asymmetry of Lip Following Lip Reconstruction in Patients with Oral Squamous Cell Carcinoma" (Registration Number L-152732/2024). This groundbreaking development addresses a critical gap in post-operative assessment protocols, providing clinicians with a standardized methodology for evaluating functional and aesthetic outcomes following complex lip reconstruction procedures.