PP170: Functional reconstruction after subtotal glossectomy in the surgical treatment of an uncommon and aggressive neoplasm in this location: Primary malignant melanoma in the base of the tongue

Abstract

Purpose Primary malignant melanoma in oral cavity is rare neoplasm (according literature about 0.2–8% of the total of these tumors). In the oral cavity, they appear with more frequency in maxillary gingiva, palate mucosa and lips. However, primary malignant melanoma is specifically uncommon in the tongue. In the literature, only about 30 cases have been reported. The aim of this work is to show the functional reconstructive treatment after subtotal glossectomy due a rare and aggressive tumor. Materials and methods A 51-year-old man was referred to our department due to an asymptomatic pigmented lesion in the base of the tongue. On examination, a black, pigmented and diffuse mass measuring approximately 3 cm in size was found on the base of the tongue. There was no significant cervical lymphadenopathy. Biopsy of the tongue lesion revealed a histopathology consistent with primary malignant melanoma. Whole-body Computed Tomography (CT scan) and Positron Emission Tomography (PET scan) does not revealed distant metastatic lesions. Patient was treated by preoperative tracheotomy, subtotal glossectomy and bilateral functional neck dissection. The defect was reconstructed by an anterolateral thigh microvascularized free flap. Surgical treatment was supplemented with adjuvant radiotherapy and chemotherapy. Results The histopathological findings revealed a malignant melanoma. The resection margin and base of the tumor were clear and no evidence of metastasis was found in the tissue of the functional neck dissection. The postoperative course was uneventful. At present, one year after surgery, patient is asymptomatic, there isn’t evidence of recurrence of melanoma and he has not any difficulty in swallowing or phonation. Conclusions Melanomas in the tongue are rare neoplasms. Treatment of mucosal melanomas should be aggressive, due to their poor prognosis. Nevertheless, it’s possible the functional reconstructive treatment that preserves swallowing or phonation. For this, microsurgical reconstruction with anterolateral thigh free flap is an adequate option.