Intra-oral spitzoid Malignant Melanoma- unexpected diagnosis of a fibroepithelial polyp

Introduction: Primary malignant melanoma is a rare in the oral cavity. Primary oral melanoma represents 0.2-8% of all melanomas and accounts for 0.5% of all oral malignancies. The most frequent site of occurrence are the palate and maxillary gingivae accounting for 80% of all oral melanomas. Spitzoid melanoma is cutaneous malignancy and occurs commonly in on the head and extremities. Spitzoid melanoma shares many histopathologic features with Spitz nevus, it is one of the most difficult lesions to diagnose in dermatopathology. There is indeed uncertainty in the medical literature about how to diagnose melanocytic proliferations including Spitz nevus and spitzoid melanoma. Case: A fifty year male was referred with an asymptomatic intraoral lump of several months duration which was reported as slowly increasing in size. Excison biopsy was undertaken and histology revealed a compound, nonulcerated, poorly pigmented melanocytic lesion with mitotic and spitzoid changes. There was no inflammation, lymphovascular or perineural invasion. The lesion was diagnosed as an incompletely excised spitzoid melanoma. Further wide local excision with 5 mm margin was found to have a focus of Spitzoid melanoma. A second wide local excision was clear of residual tumour. CT staging skull base to diaphragm was clear of any metastatic disease and the patient remains disease free one year later. Conclusion: Intra-oral Spitzoid Melanoma is a rare. The management is surgical excision. Guidelines for its management however are not well established due to the small numbers of cases reported.