Treatment

The lesion was biopsied under local anesthesia. The results of the incisional biopsy led to a referral to an ENT surgeon for further treatment. In November of 2008 she underwent a right partial maxillectomy. Since her surgery she has lost approximately 10 pounds, primarily due to difficulty with swallowing. However, her swallowing has since improved.

Incisional and excisional biopsy

Histologic examination of the H & E section revealed numerous atypical melanocytes with varying degrees of cellular and nuclear pleomorphism and large nuclei with prominent nucleoli (Figures 2 & 3). The atypical melanocytes involved most of the superficial epithelium and also invaded the superficial lamina propria (Figures 2 & 3). The depth of invasion of the incisional biopsy was 1.1 mm while that of the surgical specimen was 4 mm. The neoplastic cells were actively producing and releasing melanin pigment. The immunohistochemistry stain was uniformly positive with Melan-A (Figure 4) and with S-100 antibodies (Figure 5).

Figure 2 Low power (x100) histology shows H & E stained section with surface epithelium exhibiting atypical melanocytes with varying degrees of cellular and nuclear pleomorphism and large nuclei with prominent nucleoli. The cells invade the superficial lamina propria by 1.1 mm.

Figure 3 Higher power (x200) histology shows the atypical melanocytes high within the surface epithelium as well as invading the superficial lamina propria. Note the amount of melanin produced by these cells.

Figure 4 Low power (x40) Immunohistochemistry stain with Melan A antibody. Note the uniform positive epithelial staining most in the surface epithelium but some in the superficial connective tissue.

Figure 5Low power (x40) Immunohistochemistry stain with S-100 protein. Note the uniform positive epithelial staining most in the surface epithelium but some in the superficial connective tissue.