Head and neck mucosal melanomas

Mucosal melanoma is a rare form of melanoma, that accounts for only 1 in 100 of all the melanomas diagnosed. It can affect any of the mucous membranes that line the cavities in our body. Over half of all mucosal melanomas diagnosed are in the head and neck area.

Types of head and neck melanoma

  • Oral mucosal melanoma – This arises in the in the mouth
  • Sinonasal mucosal melanoma  – This occurs in the nasal passages or sinuses
  • Pharyngeal/ laryngeal mucosal melanoma – This affects the throat and is the least common head and neck mucosal melanoma

What are the causes?

The causes of head and neck mucosal melanoma remain largely unknown. Although some studies have shown links to smoking, ill-fitting dentures, ingested/inhaled carcinogens (tobacco and formaldehyde) for oral and sinonasal mucosal melanoma [1,2], further research is required to confirm the link.

Symptoms

The symptoms of the different types of head and neck mucosal melanoma can be difficult to pick up. This is because they are often associated with lots of other minor conditions. Therefore, they rely on your GP eliminating the many other harmless causes of these symptoms.

Possible symptoms you may see:

Oral mucosal melanoma

  • A lump on the tongue, or in the mouth that is growing in size, present for at least 3 weeks (it may or may not bleed, or be darkly pigmented)
  • A mouth ulcer that has not improved in 3 weeks

Sinonasal mucosal melanoma

  • Repeated nosebleeds out of only one nostril over at least a 3-week period
  • Blockage of one nostril that has occurred several times over a minimum of 3 weeks (nose drops do not help).

Pharyngeal/ laryngeal mucosal melanoma

  • Unexplained hoarseness that hasn’t improved in 3 weeks
  • Swollen glands in the neck that havent got better in 3 weeks

It is important you see your GP if you have symptoms or any ongoing unexplained symptoms that are worrying you.  If your GP cannot find another cause for these symptoms, you should be referred quickly (normally within about two weeks) to a head and neck clinic, in a specialist hospital for tests and further evaluation.

Head and neck mucosal melanoma: Diagnosis and staging

During your appointment your suspected tumour will be examined and a biopsy is usually taken. This is a small sample of the tissue, that will be removed under local anaesthetic. It is then analysed by a pathologist (a specialised doctor who diagnoses diseases from tissue and cells in the body) to determine whether it is a melanoma or not. It typically takes a few weeks to receive the results of your biopsy and this can be a very anxious time.  You may have other tests to help diagnose head and neck mucosal melanoma and these tests can also be used to check if the melanoma has spread to other parts of the body.

Staging for head and neck mucosal melanoma 

After a diagnosis of head and neck mucosal melanoma, your medical team will work out the ‘stage’.  The stage is a way of describing the key features of your melanoma and is helpful in guiding the best treatment and follow-up for you.  Your stage provides an indication of how advanced your melanoma is.  Staging for mucosal melanoma of the head and neck follows the American Joint Committee on Cancer (AJCC) Tumour, Node, and Metastasis (TNM) classification as follows:

T3 = Mucosal disease (localised melanoma in the mucosal area which means that it has not spread anywhere else)

T4a = Moderately advanced disease that’s spread to other tissue types (e.g. soft tissue, cartilage and skin).

T4b = Advanced disease that has spread more extensively (e.g nerves, arteries, the brain and skull).

Head and neck mucosal melanoma: Treatment

Surgery

The main treatment for a mucosal melanoma is surgery, which should be done by a surgeon who is very experienced in complex head and neck surgery. This is often in a specialised centre where there would be support from an experienced cancer team.

Other possible treatments

If the head and neck mucosal melanoma has spread elsewhere, you may be offered other treatments or the option of taking part in a clinical trial.  For more information on clinical trials, please visit the Melanoma TrialFinder

If you have any questions about your diagnosis or treatment, our specialised Melanoma Helpline nurses are here to support you on 0808 801 0777

References

Carvajal RD, Spencer SA, Lydiatt W. Mucosal Melanoma: A Clinically and Biologically Unique Disease Entity. J Natl Compr Canc Netw (2012) 10(3):345–56. doi: 10.6004/jnccn.2012.0034

Femiano F, Lanza A, Buonaiuto C, Gombos F, Di Spirito F, Cirillo N. Oral Malignant Melanoma: A Review of the Literature. J Oral Pathol Med (2008) 37(7):383–8. doi: 10.1111/j.1600-0714.2008.00660.