Melanoma Metastatic to the Mandible: Symptoms Precede Imaging Findings.

Background: Malignant melanoma is an aggressive and unpredictable cancer with the propensity for widespread metastasis. Whilst metastatic spread to the axial skeleton is relatively common, metastasis to the jaws is rarely reported and the optimal approach to investigation and management is yet to be defined.

Case presentation: A 58-year-old woman presented with dental pain, swelling and mental neuropathy on a background of an excised cutaneous melanoma. Early radiological investigations showed non-specific osteolysis despite strong clinical findings. It was not until later that magnetic resonance imaging showed changes consistent with metastatic disease. Dental extraction and biopsy confirmed the diagnosis of metastatic melanoma to the mandible.

Conclusion: Metastatic melanoma to the mandible is a rare phenomenon which may arise many years following treatment of the cutaneous primary. This case demonstrates the difficulties in early diagnosis as symptoms preceded radiographic findings using high-resolution modalities. Earlier use of magnetic resonance imaging with or without the use of bone scintigraphy may provide the sensitivity required for early identification of metastatic disease in the mandible.