Melanoma of the Oral Cavity

Primary oral melanoma (POM) is a rare disease, but is associated with significant mortality. Due to its largely asymptomatic nature, patients with POM often present late and the disease may be locally advanced or have even metastasized at the time of diagnosis. Therefore, having confirmed the diagnosis histologically, staging examinations, including ultrasound of local regional lymph nodes, magnetic resonance imaging, (positron emission) computer tomography and bone scintigraphy are important not only to determine the extent of the disease, but to help guide decisions regarding the nature and extent of surgical intervention. When possible, full surgical resection with clear resection margins is desirable. Lymph node dissection and/or radiotherapy may be considered when lymph nodes are involved. However, evidence that lymph node dissection and/or radiotherapy improve overall survival is lacking, although it may help in securing loco-regional disease control. The treatment of metastatic POM currently centers on the use of immune checkpoint inhibition, although its efficacy remains below that seen in the treatment of metastatic cutaneous melanoma. Further studies are required to gain new insights into disease pathogenesis and to identify much needed novel treatment targets.