Vol 26, No 2 (2021)
Case report
Published online: 2021-03-04

open access

Page views 918
Article views/downloads 582
Get Citation

Connect on Social Media

Connect on Social Media

A rare case of melanotic hyperpigmentation of the tongue secondary to radiotherapy

Orla A. Houlihan1, Guhan Rangaswamy1, Orla McArdle1
Rep Pract Oncol Radiother 2021;26(2):320-323.

Abstract

Melanotic hyperpigmentation of the mucosa secondary to radiotherapy is a rare occurrence. It is a diagnosis of exclusion. Literature review has identified only two case reports published to date. We present a case of a patient treated at our institution.

An 18-year-old male patient of Nigerian descent underwent radical radiotherapy (36 Gy in 18 daily fractions) to his right neck for paediatric type follicular lymphoma over a period of four weeks. He developed hyperpigmented tongue lesions during the third week of radiotherapy. There was no associated tongue discomfort, inflammation, infection, or pigmentation change elsewhere in the oral mucosa. Review of medications and past medical history did not demonstrate any potential contributing factors. Full blood count and biochemistry, morning cortisol levels and coagulation screen were all normal apart from mild neutropenia and lymphopenia. His oral cavity received a mean dose of 16.4 Gy, with the right side of his tongue receiving up to 37.5 Gy as this was within the planning target volume (PTV). He had an excellent response to radiotherapy and remains in remission. The tongue lesions resolved spontaneously 3 months post treatment.

Article available in PDF format

View PDF Download PDF file

References

  1. Chandra S, Keluskar V, Bagewadi A, et al. Extensive physiologic melanin pigmentation on the tongue: An unusual clinical presentation. Contemp Clin Dent. 2010; 1(3): 204–206.
  2. Gurguta C, Kauer C, Bergholz U, et al. Tongue and skin hyperpigmentation during PEG-interferon-alpha/ribavirin therapy in dark-skinned non-Caucasian patients with chronic hepatitis C. Am J Gastroenterol. 2006; 101(1): 197–198.
  3. de Moraes PC, Noce CW, Thomaz LA, et al. Tongue hyperpigmentation resulting from peginterferon alfa and ribavirin combination therapy: a case report. J Am Dent Assoc. 2009; 140(11): 1377–1379.
  4. Willems M, Munte K, Vrolijk JM, et al. Hyperpigmentation during interferon-alpha therapy for chronic hepatitis C virus infection. Br J Dermatol. 2003; 149(2): 390–394.
  5. Stringer LL, Zitella L. Hyperpigmentation of the tongue. J Adv Pract Oncol. 2014; 5(1): 71–72.
  6. Sarkar SB, Sarkar S, Ghosh S, et al. Addison's disease. Contemp Clin Dent. 2012; 3(4): 484–486.
  7. Rowland HN, Schnetler JF. Primary malignant melanoma arising in the dorsum of the tongue. Br J Oral Maxillofac Surg. 2003; 41(3): 197–198.
  8. Kauzman A, Pavone M, Blanas N, et al. Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations. J Can Dent Assoc. 2004; 70(10): 682–683.
  9. Meleti M, Vescovi P, Mooi WJ, et al. Pigmented lesions of the oral mucosa and perioral tissues: a flow-chart for the diagnosis and some recommendations for the management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105(5): 606–616.
  10. Amdur RJ, Sandow PR, Yeung A, et al. Melanocytic hyperpigmentation of the tongue from low-dose radiotherapy. J Hong Kong Coll Radiol. 2010; 13: 32–5.
  11. Barrett AW, Porter SR, Scully C, et al. Oral melanotic macules that develop after radiation therapy. Oral Surg Oral Med Oral Pathol. 1994; 77(4): 431–434.
  12. Brenner M, Hearing VJ. What are melanocytes really doing all day long...? : from the viewpoint of a keratinocyte: melanocytes - cells with a secret identity and incomparable abilities. Exp Dermatol. 2009; 18(9): 800–802.
  13. Randhawa M, Huff T, Valencia JC, et al. Evidence for the ectopic synthesis of melanin in human adipose tissue. FASEB J. 2009; 23(3): 835–843.
  14. Gaeta GM, Satriano RA, Baroni A. Oral pigmented lesions. Clin Dermatol. 2002; 20(3): 286–288.



Reports of Practical Oncology and Radiotherapy