Quiz: Melanoma

Up to 40% of dogs with malignant melanoma have metastatic disease when staging is performed, whereas only 30% to 40% of dogs with digital malignant melanoma have metastatic disease at time of diagnosis.¹

Malignant melanoma is the most common oral tumor in dogs, followed by squamous cell carcinoma, fibrosarcoma, and epulides. The most common oral tumors in cats (in decreasing order of frequency) include squamous cell carcinoma, lymphoma, osteosarcoma, and melanoma.¹

Metastatic sites involve draining lymph nodes, lungs, liver, and other vascular-rich organs.¹ On cytology, melanocytes can have a round cell, epithelial cell, or mesenchymal cell appearance.^1,2

Up to 40% of dogs with malignant melanoma have metastatic disease when staging is performed, whereas only 30% to 40% of dogs with digital malignant melanoma have metastatic disease at time of diagnosis.¹

Malignant melanoma is the most common oral tumor in dogs, followed by squamous cell carcinoma, fibrosarcoma, and epulides. The most common oral tumors in cats (in decreasing order of frequency) include squamous cell carcinoma, lymphoma, osteosarcoma, and melanoma.¹

Metastatic sites involve draining lymph nodes, lungs, liver, and other vascular-rich organs.¹ On cytology, melanocytes can have a round cell, epithelial cell, or mesenchymal cell appearance.^1,2

Up to 40% of dogs with malignant melanoma have metastatic disease when staging is performed, whereas only 30% to 40% of dogs with digital malignant melanoma have metastatic disease at time of diagnosis.¹

Malignant melanoma is the most common oral tumor in dogs, followed by squamous cell carcinoma, fibrosarcoma, and epulides. The most common oral tumors in cats (in decreasing order of frequency) include squamous cell carcinoma, lymphoma, osteosarcoma, and melanoma.¹

Metastatic sites involve draining lymph nodes, lungs, liver, and other vascular-rich organs.¹ On cytology, melanocytes can have a round cell, epithelial cell, or mesenchymal cell appearance.^1,2

Up to 40% of dogs with malignant melanoma have metastatic disease when staging is performed, whereas only 30% to 40% of dogs with digital malignant melanoma have metastatic disease at time of diagnosis.¹

Malignant melanoma is the most common oral tumor in dogs, followed by squamous cell carcinoma, fibrosarcoma, and epulides. The most common oral tumors in cats (in decreasing order of frequency) include squamous cell carcinoma, lymphoma, osteosarcoma, and melanoma.¹

Metastatic sites involve draining lymph nodes, lungs, liver, and other vascular-rich organs.¹ On cytology, melanocytes can have a round cell, epithelial cell, or mesenchymal cell appearance.^1,2

Up to 40% of dogs with malignant melanoma have metastatic disease when staging is performed, whereas only 30% to 40% of dogs with digital malignant melanoma have metastatic disease at time of diagnosis.¹

Malignant melanoma is the most common oral tumor in dogs, followed by squamous cell carcinoma, fibrosarcoma, and epulides. The most common oral tumors in cats (in decreasing order of frequency) include squamous cell carcinoma, lymphoma, osteosarcoma, and melanoma.¹

Metastatic sites involve draining lymph nodes, lungs, liver, and other vascular-rich organs.¹ On cytology, melanocytes can have a round cell, epithelial cell, or mesenchymal cell appearance.^1,2

Blood work is important in assessing a patient’s overall health and potentially identifying existing comorbidities that may impact treatment but would not be a factor in determining prognosis of patients with melanoma.^1,3  

Physical examination is important to establish overall health and tumor location as well as monitor for any new masses or evidence of metastasis.^1,3 Lymph nodes should also be checked for metastasis, as their size is not always indicative of metastatic disease.^1,4 According to one study in dogs with oral malignant melanoma, 40% of normal-sized lymph nodes were positive on testing for metastatic disease.⁴

Thoracic radiography is essential for disease staging and prognosis. In addition, abdominal ultrasonography can be performed as malignant melanoma can metastasize (although infrequently) to the liver, adrenal glands, and other intraabdominal organs.^1,4

Blood work is important in assessing a patient’s overall health and potentially identifying existing comorbidities that may impact treatment but would not be a factor in determining prognosis of patients with melanoma.^1,3  

Physical examination is important to establish overall health and tumor location as well as monitor for any new masses or evidence of metastasis.^1,3 Lymph nodes should also be checked for metastasis, as their size is not always indicative of metastatic disease.^1,4 According to one study in dogs with oral malignant melanoma, 40% of normal-sized lymph nodes were positive on testing for metastatic disease.⁴

Thoracic radiography is essential for disease staging and prognosis. In addition, abdominal ultrasonography can be performed as malignant melanoma can metastasize (although infrequently) to the liver, adrenal glands, and other intraabdominal organs.^1,4

Blood work is important in assessing a patient’s overall health and potentially identifying existing comorbidities that may impact treatment but would not be a factor in determining prognosis of patients with melanoma.^1,3  

Physical examination is important to establish overall health and tumor location as well as monitor for any new masses or evidence of metastasis.^1,3 Lymph nodes should also be checked for metastasis, as their size is not always indicative of metastatic disease.^1,4 According to one study in dogs with oral malignant melanoma, 40% of normal-sized lymph nodes were positive on testing for metastatic disease.⁴

Thoracic radiography is essential for disease staging and prognosis. In addition, abdominal ultrasonography can be performed as malignant melanoma can metastasize (although infrequently) to the liver, adrenal glands, and other intraabdominal organs.^1,4

Blood work is important in assessing a patient’s overall health and potentially identifying existing comorbidities that may impact treatment but would not be a factor in determining prognosis of patients with melanoma.^1,3  

Physical examination is important to establish overall health and tumor location as well as monitor for any new masses or evidence of metastasis.^1,3 Lymph nodes should also be checked for metastasis, as their size is not always indicative of metastatic disease.^1,4 According to one study in dogs with oral malignant melanoma, 40% of normal-sized lymph nodes were positive on testing for metastatic disease.⁴

Thoracic radiography is essential for disease staging and prognosis. In addition, abdominal ultrasonography can be performed as malignant melanoma can metastasize (although infrequently) to the liver, adrenal glands, and other intraabdominal organs.^1,4

Blood work is important in assessing a patient’s overall health and potentially identifying existing comorbidities that may impact treatment but would not be a factor in determining prognosis of patients with melanoma.^1,3  

Physical examination is important to establish overall health and tumor location as well as monitor for any new masses or evidence of metastasis.^1,3 Lymph nodes should also be checked for metastasis, as their size is not always indicative of metastatic disease.^1,4 According to one study in dogs with oral malignant melanoma, 40% of normal-sized lymph nodes were positive on testing for metastatic disease.⁴

Thoracic radiography is essential for disease staging and prognosis. In addition, abdominal ultrasonography can be performed as malignant melanoma can metastasize (although infrequently) to the liver, adrenal glands, and other intraabdominal organs.^1,4

Ki67 reactivity is a measurement of nuclear protein that is expressed during the cell cycle and used to assess tumor growth.^1,5,6 An increased Ki67 value or mitotic index is indicative of a rapidly growing tumor.^1,5,6  Mitotic index should be included in the histopathology report, while the immunohistochemical stain, Ki67, is an additional test that must be requested.

Oral melanomas are aggressive forms that usually metastasize to draining lymph nodes.^1,6,7 Contralateral lymph node metastasis can occur.^6,7 Lack of melanin or amelanotic melanomas are also indicative of aggressive disease.^1,6  

Nuclear atypia occurs during transformation from a well-differentiated cell (eg, has nucleolus in center of the nucleus) to an undifferentiated cell (ie, immature looking).^1,2,6 During transformation, the nucleoli enlarge, increase in number, or develop an irregular shape and move closer to the nuclear membrane.^1,2,6

Ki67 reactivity is a measurement of nuclear protein that is expressed during the cell cycle and used to assess tumor growth.^1,5,6 An increased Ki67 value or mitotic index is indicative of a rapidly growing tumor.^1,5,6  Mitotic index should be included in the histopathology report, while the immunohistochemical stain, Ki67, is an additional test that must be requested.

Oral melanomas are aggressive forms that usually metastasize to draining lymph nodes.^1,6,7 Contralateral lymph node metastasis can occur.^6,7 Lack of melanin or amelanotic melanomas are also indicative of aggressive disease.^1,6  

Nuclear atypia occurs during transformation from a well-differentiated cell (eg, has nucleolus in center of the nucleus) to an undifferentiated cell (ie, immature looking).^1,2,6 During transformation, the nucleoli enlarge, increase in number, or develop an irregular shape and move closer to the nuclear membrane.^1,2,6

Ki67 reactivity is a measurement of nuclear protein that is expressed during the cell cycle and used to assess tumor growth.^1,5,6 An increased Ki67 value or mitotic index is indicative of a rapidly growing tumor.^1,5,6  Mitotic index should be included in the histopathology report, while the immunohistochemical stain, Ki67, is an additional test that must be requested.

Oral melanomas are aggressive forms that usually metastasize to draining lymph nodes.^1,6,7 Contralateral lymph node metastasis can occur.^6,7 Lack of melanin or amelanotic melanomas are also indicative of aggressive disease.^1,6  

Nuclear atypia occurs during transformation from a well-differentiated cell (eg, has nucleolus in center of the nucleus) to an undifferentiated cell (ie, immature looking).^1,2,6 During transformation, the nucleoli enlarge, increase in number, or develop an irregular shape and move closer to the nuclear membrane.^1,2,6

Ki67 reactivity is a measurement of nuclear protein that is expressed during the cell cycle and used to assess tumor growth.^1,5,6 An increased Ki67 value or mitotic index is indicative of a rapidly growing tumor.^1,5,6  Mitotic index should be included in the histopathology report, while the immunohistochemical stain, Ki67, is an additional test that must be requested.

Oral melanomas are aggressive forms that usually metastasize to draining lymph nodes.^1,6,7 Contralateral lymph node metastasis can occur.^6,7 Lack of melanin or amelanotic melanomas are also indicative of aggressive disease.^1,6  

Nuclear atypia occurs during transformation from a well-differentiated cell (eg, has nucleolus in center of the nucleus) to an undifferentiated cell (ie, immature looking).^1,2,6 During transformation, the nucleoli enlarge, increase in number, or develop an irregular shape and move closer to the nuclear membrane.^1,2,6

Ki67 reactivity is a measurement of nuclear protein that is expressed during the cell cycle and used to assess tumor growth.^1,5,6 An increased Ki67 value or mitotic index is indicative of a rapidly growing tumor.^1,5,6  Mitotic index should be included in the histopathology report, while the immunohistochemical stain, Ki67, is an additional test that must be requested.

Oral melanomas are aggressive forms that usually metastasize to draining lymph nodes.^1,6,7 Contralateral lymph node metastasis can occur.^6,7 Lack of melanin or amelanotic melanomas are also indicative of aggressive disease.^1,6  

Nuclear atypia occurs during transformation from a well-differentiated cell (eg, has nucleolus in center of the nucleus) to an undifferentiated cell (ie, immature looking).^1,2,6 During transformation, the nucleoli enlarge, increase in number, or develop an irregular shape and move closer to the nuclear membrane.^1,2,6

Even though lip melanomas are typically malignant, patients undergoing surgical excision with adequate margins followed by systemic therapy tend to have a longer survival time than do patients undergoing surgery only (ie, surgery alone, 18 months; surgery plus melanoma vaccination, >20 months).¹

A majority of dermal melanomas are benign, and wide surgical excision is usually curative.^1,8 Subungual (nail bed) melanomas are malignant, and surgical removal of the entire digit is therefore recommended.^1,8 Prior to surgery, staging with aspiration of local lymph nodes and thoracic radiography, are recommended. Following surgery, systemic therapy (ie, melanoma vaccination; rarely, chemotherapy) is the recommended treatment approach.¹

Although treatment of ocular melanoma can vary among species, enucleation or exenteration is generally performed.¹ More than 60% of feline ocular melanomas arise from the iris, while approximately 80% of canine ocular melanomas originate from the anterior uvea.^1,8

Even though lip melanomas are typically malignant, patients undergoing surgical excision with adequate margins followed by systemic therapy tend to have a longer survival time than do patients undergoing surgery only (ie, surgery alone, 18 months; surgery plus melanoma vaccination, >20 months).¹

A majority of dermal melanomas are benign, and wide surgical excision is usually curative.^1,8 Subungual (nail bed) melanomas are malignant, and surgical removal of the entire digit is therefore recommended.^1,8 Prior to surgery, staging with aspiration of local lymph nodes and thoracic radiography, are recommended. Following surgery, systemic therapy (ie, melanoma vaccination; rarely, chemotherapy) is the recommended treatment approach.¹

Although treatment of ocular melanoma can vary among species, enucleation or exenteration is generally performed.¹ More than 60% of feline ocular melanomas arise from the iris, while approximately 80% of canine ocular melanomas originate from the anterior uvea.^1,8

Even though lip melanomas are typically malignant, patients undergoing surgical excision with adequate margins followed by systemic therapy tend to have a longer survival time than do patients undergoing surgery only (ie, surgery alone, 18 months; surgery plus melanoma vaccination, >20 months).¹

A majority of dermal melanomas are benign, and wide surgical excision is usually curative.^1,8 Subungual (nail bed) melanomas are malignant, and surgical removal of the entire digit is therefore recommended.^1,8 Prior to surgery, staging with aspiration of local lymph nodes and thoracic radiography, are recommended. Following surgery, systemic therapy (ie, melanoma vaccination; rarely, chemotherapy) is the recommended treatment approach.¹

Although treatment of ocular melanoma can vary among species, enucleation or exenteration is generally performed.¹ More than 60% of feline ocular melanomas arise from the iris, while approximately 80% of canine ocular melanomas originate from the anterior uvea.^1,8

Even though lip melanomas are typically malignant, patients undergoing surgical excision with adequate margins followed by systemic therapy tend to have a longer survival time than do patients undergoing surgery only (ie, surgery alone, 18 months; surgery plus melanoma vaccination, >20 months).¹

A majority of dermal melanomas are benign, and wide surgical excision is usually curative.^1,8 Subungual (nail bed) melanomas are malignant, and surgical removal of the entire digit is therefore recommended.^1,8 Prior to surgery, staging with aspiration of local lymph nodes and thoracic radiography, are recommended. Following surgery, systemic therapy (ie, melanoma vaccination; rarely, chemotherapy) is the recommended treatment approach.¹

Although treatment of ocular melanoma can vary among species, enucleation or exenteration is generally performed.¹ More than 60% of feline ocular melanomas arise from the iris, while approximately 80% of canine ocular melanomas originate from the anterior uvea.^1,8

Even though lip melanomas are typically malignant, patients undergoing surgical excision with adequate margins followed by systemic therapy tend to have a longer survival time than do patients undergoing surgery only (ie, surgery alone, 18 months; surgery plus melanoma vaccination, >20 months).¹

A majority of dermal melanomas are benign, and wide surgical excision is usually curative.^1,8 Subungual (nail bed) melanomas are malignant, and surgical removal of the entire digit is therefore recommended.^1,8 Prior to surgery, staging with aspiration of local lymph nodes and thoracic radiography, are recommended. Following surgery, systemic therapy (ie, melanoma vaccination; rarely, chemotherapy) is the recommended treatment approach.¹

Although treatment of ocular melanoma can vary among species, enucleation or exenteration is generally performed.¹ More than 60% of feline ocular melanomas arise from the iris, while approximately 80% of canine ocular melanomas originate from the anterior uvea.^1,8

Oncept (Merial, petcancervaccine.com) is a xenogenic plasmid DNA canine vaccine with a human tyrosinase cDNA insert. This vaccine stimulates the immune system to develop antibodies against tyrosinase,^1,7,9-12 a glycoprotein that is essential for the production of melanin.^1,7

This vaccine is administered via a transdermal device every 2 weeks for 4 treatments initially, followed by a booster injection every 6 months.^1,7,9,11 Although amelanotic melanomas have less tyrosinase, the vaccine can still be useful in helping to prevent metastasis.⁹ In addition, even though the vaccine is labeled for canine melanoma only, it is safe for use in dogs, cats, and horses.^13,14  In cats, the injection site is located on the medial or lateral aspect of the thigh, caudal to the femur.¹⁴ In dogs, the vaccine is administered on the medial aspect of the thigh, while in horses, it is given at the deep pectoral muscle.¹³

Oncept (Merial, petcancervaccine.com) is a xenogenic plasmid DNA canine vaccine with a human tyrosinase cDNA insert. This vaccine stimulates the immune system to develop antibodies against tyrosinase,^1,7,9-12 a glycoprotein that is essential for the production of melanin.^1,7

This vaccine is administered via a transdermal device every 2 weeks for 4 treatments initially, followed by a booster injection every 6 months.^1,7,9,11 Although amelanotic melanomas have less tyrosinase, the vaccine can still be useful in helping to prevent metastasis.⁹ In addition, even though the vaccine is labeled for canine melanoma only, it is safe for use in dogs, cats, and horses.^13,14  In cats, the injection site is located on the medial or lateral aspect of the thigh, caudal to the femur.¹⁴ In dogs, the vaccine is administered on the medial aspect of the thigh, while in horses, it is given at the deep pectoral muscle.¹³

Oncept (Merial, petcancervaccine.com) is a xenogenic plasmid DNA canine vaccine with a human tyrosinase cDNA insert. This vaccine stimulates the immune system to develop antibodies against tyrosinase,^1,7,9-12 a glycoprotein that is essential for the production of melanin.^1,7

This vaccine is administered via a transdermal device every 2 weeks for 4 treatments initially, followed by a booster injection every 6 months.^1,7,9,11 Although amelanotic melanomas have less tyrosinase, the vaccine can still be useful in helping to prevent metastasis.⁹ In addition, even though the vaccine is labeled for canine melanoma only, it is safe for use in dogs, cats, and horses.^13,14  In cats, the injection site is located on the medial or lateral aspect of the thigh, caudal to the femur.¹⁴ In dogs, the vaccine is administered on the medial aspect of the thigh, while in horses, it is given at the deep pectoral muscle.¹³

Oncept (Merial, petcancervaccine.com) is a xenogenic plasmid DNA canine vaccine with a human tyrosinase cDNA insert. This vaccine stimulates the immune system to develop antibodies against tyrosinase,^1,7,9-12 a glycoprotein that is essential for the production of melanin.^1,7

This vaccine is administered via a transdermal device every 2 weeks for 4 treatments initially, followed by a booster injection every 6 months.^1,7,9,11 Although amelanotic melanomas have less tyrosinase, the vaccine can still be useful in helping to prevent metastasis.⁹ In addition, even though the vaccine is labeled for canine melanoma only, it is safe for use in dogs, cats, and horses.^13,14  In cats, the injection site is located on the medial or lateral aspect of the thigh, caudal to the femur.¹⁴ In dogs, the vaccine is administered on the medial aspect of the thigh, while in horses, it is given at the deep pectoral muscle.¹³

Oncept (Merial, petcancervaccine.com) is a xenogenic plasmid DNA canine vaccine with a human tyrosinase cDNA insert. This vaccine stimulates the immune system to develop antibodies against tyrosinase,^1,7,9-12 a glycoprotein that is essential for the production of melanin.^1,7

This vaccine is administered via a transdermal device every 2 weeks for 4 treatments initially, followed by a booster injection every 6 months.^1,7,9,11 Although amelanotic melanomas have less tyrosinase, the vaccine can still be useful in helping to prevent metastasis.⁹ In addition, even though the vaccine is labeled for canine melanoma only, it is safe for use in dogs, cats, and horses.^13,14  In cats, the injection site is located on the medial or lateral aspect of the thigh, caudal to the femur.¹⁴ In dogs, the vaccine is administered on the medial aspect of the thigh, while in horses, it is given at the deep pectoral muscle.¹³

Of the common forms of melanoma, dermal melanoma tends to be benign and can be cured with surgical removal.¹ However, a small subset of dermal melanomas is malignant. In those instances, adjuvant therapy (eg, radiation therapy, melanoma vaccination, chemotherapy) may be warranted to slow metastasis.¹

Oral melanomas are malignant and generally associated with poor survival times. The overall survival time ranges from 3 to 18 months with surgery alone, depending on location and stage. Local recurrence occurs in 22% to 48% of dogs. Local control (ie, surgery, radiation therapy) and systemic therapy (ie, melanoma vaccination, chemotherapy) are important in the control of distant metastases with oral malignant melanoma.¹ 

Subungual (nail bed) melanomas are also malignant and associated with poor survival times (ie, 1- and 2-year survival times of 42% and 11%, respectively). Digital amputation and adjuvant treatment (melanoma vaccine) are recommended.^1,15

Amelanotic melanomas tend to be more aggressive than melanotic melanomas. Rostral mandibulectomy has the potential for complete local control; however, adjuvant therapies are also warranted to control metastatic disease. Death is usually attributed to metastatic disease.¹

Of the common forms of melanoma, dermal melanoma tends to be benign and can be cured with surgical removal.¹ However, a small subset of dermal melanomas is malignant. In those instances, adjuvant therapy (eg, radiation therapy, melanoma vaccination, chemotherapy) may be warranted to slow metastasis.¹

Oral melanomas are malignant and generally associated with poor survival times. The overall survival time ranges from 3 to 18 months with surgery alone, depending on location and stage. Local recurrence occurs in 22% to 48% of dogs. Local control (ie, surgery, radiation therapy) and systemic therapy (ie, melanoma vaccination, chemotherapy) are important in the control of distant metastases with oral malignant melanoma.¹ 

Subungual (nail bed) melanomas are also malignant and associated with poor survival times (ie, 1- and 2-year survival times of 42% and 11%, respectively). Digital amputation and adjuvant treatment (melanoma vaccine) are recommended.^1,15

Amelanotic melanomas tend to be more aggressive than melanotic melanomas. Rostral mandibulectomy has the potential for complete local control; however, adjuvant therapies are also warranted to control metastatic disease. Death is usually attributed to metastatic disease.¹

Of the common forms of melanoma, dermal melanoma tends to be benign and can be cured with surgical removal.¹ However, a small subset of dermal melanomas is malignant. In those instances, adjuvant therapy (eg, radiation therapy, melanoma vaccination, chemotherapy) may be warranted to slow metastasis.¹

Oral melanomas are malignant and generally associated with poor survival times. The overall survival time ranges from 3 to 18 months with surgery alone, depending on location and stage. Local recurrence occurs in 22% to 48% of dogs. Local control (ie, surgery, radiation therapy) and systemic therapy (ie, melanoma vaccination, chemotherapy) are important in the control of distant metastases with oral malignant melanoma.¹ 

Subungual (nail bed) melanomas are also malignant and associated with poor survival times (ie, 1- and 2-year survival times of 42% and 11%, respectively). Digital amputation and adjuvant treatment (melanoma vaccine) are recommended.^1,15

Amelanotic melanomas tend to be more aggressive than melanotic melanomas. Rostral mandibulectomy has the potential for complete local control; however, adjuvant therapies are also warranted to control metastatic disease. Death is usually attributed to metastatic disease.¹

Of the common forms of melanoma, dermal melanoma tends to be benign and can be cured with surgical removal.¹ However, a small subset of dermal melanomas is malignant. In those instances, adjuvant therapy (eg, radiation therapy, melanoma vaccination, chemotherapy) may be warranted to slow metastasis.¹

Oral melanomas are malignant and generally associated with poor survival times. The overall survival time ranges from 3 to 18 months with surgery alone, depending on location and stage. Local recurrence occurs in 22% to 48% of dogs. Local control (ie, surgery, radiation therapy) and systemic therapy (ie, melanoma vaccination, chemotherapy) are important in the control of distant metastases with oral malignant melanoma.¹ 

Subungual (nail bed) melanomas are also malignant and associated with poor survival times (ie, 1- and 2-year survival times of 42% and 11%, respectively). Digital amputation and adjuvant treatment (melanoma vaccine) are recommended.^1,15

Amelanotic melanomas tend to be more aggressive than melanotic melanomas. Rostral mandibulectomy has the potential for complete local control; however, adjuvant therapies are also warranted to control metastatic disease. Death is usually attributed to metastatic disease.¹

Of the common forms of melanoma, dermal melanoma tends to be benign and can be cured with surgical removal.¹ However, a small subset of dermal melanomas is malignant. In those instances, adjuvant therapy (eg, radiation therapy, melanoma vaccination, chemotherapy) may be warranted to slow metastasis.¹

Oral melanomas are malignant and generally associated with poor survival times. The overall survival time ranges from 3 to 18 months with surgery alone, depending on location and stage. Local recurrence occurs in 22% to 48% of dogs. Local control (ie, surgery, radiation therapy) and systemic therapy (ie, melanoma vaccination, chemotherapy) are important in the control of distant metastases with oral malignant melanoma.¹ 

Subungual (nail bed) melanomas are also malignant and associated with poor survival times (ie, 1- and 2-year survival times of 42% and 11%, respectively). Digital amputation and adjuvant treatment (melanoma vaccine) are recommended.^1,15

Amelanotic melanomas tend to be more aggressive than melanotic melanomas. Rostral mandibulectomy has the potential for complete local control; however, adjuvant therapies are also warranted to control metastatic disease. Death is usually attributed to metastatic disease.¹