Mucosal malignant melanomas.

Forty-seven cases of mucosal malignant melanomas and the recent literature are reviewed. Twenty patients had head and neck mucosal malignant melanomas; 14 had vulvar and 7 vaginal melanomas. Included are also isolated cases of urethral, anal and esophageal melanoma. Mucosal malignant melanomas are more aggressive and behave differently from cutaneous melanomas. The pathologic description and leveling system known from cutaneous melanomas are not applicable in mucosal melanomas, and other prognostic factors such as depth of invasion seem more important. Extensive surgical procedures is the favored treatment when cure is intended whereas radiation, chemotherapy and immunotherapy currently serve mainly as palliative measures. The prognosis is generally grave. In this review, 5 of the 20 patients with head and neck tumors and 3 of the patients with vulvar tumors had 5 years cures, but later recurrences are not infrequent. Two patients are alive with metastatic disease whereas the rest died from primary or recurrent disease. The main problem in head and neck tumors was gaining control over the local disease process, whereas metastatic disease was less ominous and less frequent. This was different in vulvar melanomas, in which disseminated metastatic disease made the disease difficult to control in the majority of cases. The course of the 47 patients, the poor treatment results and the rarity of the disease show the need for centralized registration and management of mucosal malignant melanomas.