Case report
A 33 years old woman presented to our clinic with a pigmented mass with
ulceration in the left posterolateral part of her tongue that was
gradually growing five months before her presentation. There was a 1 cm
pigmented ulcerated mass with a satellite smaller discoloration adjacent
to it without palpable cervical lymphadenopathy on physical exam. An
incisional biopsy was taken that turned out to be malignant melanoma.
MRI showed an enhancing lesion measuring about 14 mm ×6 mm at the
posterolateral part of the tongue without cervical lymphadenopathy.
There was no evidence of distant metastasis in chest abdominopelvic CT
scan. The patient has no history of smoking or alcohol use. Medical
history was noncontributory. Partial glossectomy with safe margins was
performed, and the defect was reconstructed with a local flap. Pathology
revealed malignant melanoma with satellite lesions with a maximum
thickness of 5-6 mm. Striated muscles were infiltrated by tumors.
Lymphovascular invasion was present. There was evidence of macroscopic
and microscopic satellite nodules. All surgical margins were free. She
refused postoperative radiotherapy but was under maintenance
imatinibR treatment due to the strong positivity of
C-KIT.
On her regular follow up there was no evidence of recurrence for about
two years. Then after, she noticed a black spot on her tongue that
gradually increased in size without any accompanying symptoms. Physical
examination revealed a 15 mm×10 mm pigmented mass at the left
posterolateral portion of her tongue, it was indurated and non-tender
without ulceration. There were no other similar lesions intraorally or
elsewhere on her body. MRI of the neck revealed an enhancing lesion
measuring about 14.6 mm at the left posterolateral portion of the tongue
related to the patient’s known pathology. Incisional biopsy of the
lesion revealed malignant mucosal melanoma. PET scan and neck
ultrasonography revealed no evidence of distant metastasis or local
lymphadenopathy. Her condition was discussed at the multidisciplinary
tumor board, and she became a candidate for surgery and adjuvant
radiotherapy. Therefore, she underwent a partial glossectomy. Fig1. The
frozen section confirmed tumor margins were free of malignant cells and
the defect reconstructed with a submental flap. Her post-op course was
uneventful. The pathology report revealed T3N0 malignant melanoma with
safe margins. Fig2. Maximum tumor thickness was 8 mm, ulceration was
present, microsatellite lesion was not identified, there was no evidence
of lymphovascular invasion nor neurotropism. Mitotic rate was 4 mitoses
per mm2. Adjuvant Radiotherapy started about one month
after surgery. She is currently undergoing regular follow-up. No local
recurrence of the lesion was found during the 3-month follow-up period.