Oral mucosal melanoma: a malignant trap

Primary mucosal melanomas of the head and neck are a rare entity, occurring much less frequently than their cutaneous counterparts. Among those of the head and neck region, oral mucosal melanoma is extremely infrequent. It accounts for only 0.5% of oral neoplasms [1]. Oral mucosal melanomas are highly malignant tumors with the tendency to metastasize or locally invade tissues more readily than other malignant tumors of the oral cavity [1].One third of the patients are asymptomatic at the time of diagnosis and episodes of hemorrhage seem to be the leading symptom [2].We present the case of a 75-year-old man who was referred to the Ear, Nose and Throat department having symptoms as voice alteration and saliva drooling, progressively worsening. The diagnosis was an oversized palate melanoma blocking the oral cavity. In this case, the delay in seeking medical care was probably due to the 'silent' course of the disease in relation to the patient's tendency to underestimate his symptoms.A 75-years-old male during an ordinary visit for drug prescription due to his chronic health problems, described his complaints (voice alteration, dysphagia and saliva drooling progressively worsening during the last few weeks) and his general physician referred him for an E.N.T. evaluation. The lack of any pain sensation was the reason for the delay of seeing a physician. His medical history was significant for severe benign prostatic hyperplasia, hypertension and chronic obstructive pulmonary disease. He was heavy tobacco smoker until recently. No history of alcohol intake was referred.Clinical examination of the oral cavity revealed an oversized pigmented soft mass arising from the left half of his hard palate involving the soft palate and the ipsilateral palatine tonsil causing partial obstruction of the oral cavity and the oropharynx (Figure 1). Some pigmented macules of various sizes were also noted growing at the periphery of the tumor. During neck palpation a 2 × 3 cm firm mobile n