新英格兰：口内黑素瘤
一60岁女性口腔钝挫伤后上牙龈出现黑色变2月。患者既往体健，无吸烟史和饮酒史。体检示上颌前牙唇侧(图A)和腭侧(图B)可及弥漫性的黑素色素沉着，无牙齿松动，未及淋巴结肿大。X线未见骨质破坏，PET-CT示上颌前牙区可及高代谢信号，未见淋巴结转移。切除活检组织病理学检查示恶性黑素瘤。口腔内的原发性恶黑不常见。不幸的是口腔恶黑早期无明显症状，因此很可能延误诊断。该患者病变切除后进行化疗。诊断后随访26月病情复发且有远处转移。
A 60-year-old woman presented with a 2-month history of black discoloration on her upper gums after blunt trauma to the mouth. She had previously been well and was a lifelong nonsmoker and nondrinker. On examination, diffuse black pigmentation was seen on both the labial and palatal sides of the anterior maxilla (Panels A and B, respectively), without tooth mobility or palpable lymphadenopathy. No bone destruction was detected on a standard dental radiograph. A hypermetabolic signal was seen in the anterior maxillary area on positron-emission tomography–computed tomography, with no metastatic spread to the lymph nodes. Incisional biopsy and histologic analysis revealed malignant melanoma. Primary malignant melanoma is uncommon in the oral cavity. Unfortunately, diagnosis may be delayed because oral malignant melanomas are frequently asymptomatic and painless in their early stages. The lesion was resected, and the patient received chemotherapy. At the last follow-up, 26 months after the initial diagnosis, she had recurrent disease and distant metastases.
原文：http://www.nejm.org/doi/full/10.1056/NEJMicm1410451
Intraoral Malignant Melanoma
A 60-year-old woman presented with a 2-month history of black discoloration on her upper gums after blunt trauma to the mouth. She had previously been well and was a lifelong nonsmoker and nondrinker. On examination, diffuse black pigmentation was seen on both the labial and palatal sides of the anterior maxilla (Panels A and B, respectively), without tooth mobility or palpable lymphadenopathy. No bone destruction was detected on a standard dental radiograph. A hypermetabolic signal was seen in the anterior maxillary area on positron-emission tomography–computed tomography, with no metastatic spread to the lymph nodes. Incisional biopsy and histologic analysis revealed malignant melanoma. Primary malignant melanoma is uncommon in the oral cavity. Unfortunately, diagnosis may be delayed because oral malignant melanomas are frequently asymptomatic and painless in their early stages. The lesion was resected, and the patient received chemotherapy. At the last follow-up, 26 months after the initial diagnosis, she had recurrent disease and distant metastases.
原文：http://www.nejm.org/doi/full/10.1056/NEJMicm1410451
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