Mucosal Melanoma

What is mucosal melanoma?

Mucosal melanoma is a rare form of melanoma. It starts in mucosa (mucous membrane), the soft tissue that lines organs and other areas throughout your body. You may develop mucosal melanoma anywhere you have mucosa, but the condition typically affects:

• The head and neck region, particularly your nose, lips and mouth.
• The anorectal region (your anus and rectum).
• The vulvovaginal region (your vagina and vulva).

Mucosal melanoma typically affects people age 70 and older. By the time it’s diagnosed, most mucosal melanoma already has spread (metastasized). Healthcare providers may be able to treat mucosal melanoma with surgery. Many times, however, providers work as a multidisciplinary team that uses several types of treatment.

Is it common?

No. The American Cancer Society estimated that more than 99,000 people would receive a melanoma diagnosis in 2022. Mucosal melanoma represented about 1% of all melanoma cases, or about 990 people.

What are mucosal melanoma symptoms?

It’s easy to miss mucosal melanoma symptoms. Mucosal melanoma develops in hidden places that you’re not likely to monitor for changes. (Think the inside of your nose or the skin around your anus.) And mucosal melanoma symptoms are similar to less serious issues, so people often don’t consider certain changes as signs of trouble. People develop different symptoms based on where the cancer starts.

Head and neck

Head and neck mucosal melanoma accounts for 31% to 51% of all mucosal melanomas. There are three types of head and neck mucosal melanoma with different symptoms:

Oral mucosa melanoma

This cancer affects your mouth, including your lips. Symptoms may include:

• A lump on your tongue that doesn’t go away or is getting larger.
• A sore in your mouth that doesn’t heal.
• Mouth pain.
• Bleeding in your mouth.
• Dentures that don’t fit well.

Sinonasal mucosal melanoma

This is cancer in your nose (nasal passages) and sinuses. Symptoms may include:

• Repeated nosebleeds from one nostril (epistaxis).
• Feeling as if something is stuck in your nose (nasal obstruction).
• Continuous runny nose.
• Facial pain.

Laryngeal/pharyngeal mucosal melanoma

This is the least common type of mucosal melanoma. It affects your throat. Symptoms may include:

• Hoarseness.
• Trouble swallowing (dysphagia).
• Sore throat (pharyngitis).
• A mass or lump on the outside of your neck.

Anus and rectum

Anorectal mucosal melanoma appears in your anus and/or rectum. This condition type accounts for an estimated 17% to 24% of all cases. Symptoms may include:

• Pain in your anus or rectum.
• A mass or lump in your anus or rectum.
• Bleeding from your anus or rectum.
• Constipation.
• Itchiness (pruritus ani).

Vulva and vagina

Vulvovaginal mucosal melanoma affects areas in your vaginal wall and vulva. It accounts for an estimated 18% of all cases. Symptoms may include:

• Vaginal bleeding that happens between periods or after menopause.
• Pain in your vagina.
• Unusual discharge from your vagina, including bloody discharge.
• A lump or growth in your vagina or vulva.
• Itching in your vagina or vulva that doesn’t go away with treatment.

What causes mucosal melanoma?

The short answer is medical researchers aren’t sure what causes mucosal melanoma. All melanomas are tumors that develop from melanocytes. Melanocytes are cells tasked with producing melanin pigment. Melanin pigment determines eye, hair and skin color. It also protects your skin and eyes from sun damage. Researchers are studying why melanocytes that protect against sun damage are located in mucosa that sunlight rarely touches.

However, researchers have discovered two genetic mutations, or changes, that may play a part in causing some mucosal melanoma. These are somatic mutations, meaning they happen during your lifetime. Mutated KIT and BRAF genes appear in a small percentage of mucosal melanoma:

• KIT: KIT genes manage how fast certain cells grow, including melanocytes. Like BRAF genes, KIT genes make a protein that drives cell growth. When KIT genes mutate, the KIT protein signals other proteins to give cells instructions to multiply and divide faster than usual. Studies show that mutations in KIT genes appear in 7% to 17% of all mucosal melanoma. In addition, they appear in about 30% of all mucosal melanoma that affects people’s vaginas and vulvas.
• BRAF: BRAF genes manage proteins that oversee the melanocyte cell population. The proteins rely on BRAF genes for instructions on how fast cells multiply and divide. When BRAF genes mutate, they change instructions, and cells begin to multiply uncontrollably, eventually becoming cancerous tumors. But BRAF mutations only occur in 3% to 15% of all mucosal melanoma.

Sun damage causes melanoma. Does it cause mucosal melanoma?

No, it doesn’t. Mucosal melanoma develops in places that aren’t exposed to sunlight, such as the inside of your nose and mouth or your anus.

How do healthcare providers diagnose mucosal melanoma?

Providers may use different imaging tests, including computed tomography (CT) scans and magnetic resonance imaging (MRI) scans. They may do biopsies to obtain cells or tissue for medical pathologists to examine. Providers may also do genetic tests to detect any genetic mutations or changes.

What is mucosal melanoma cancer staging?

Healthcare providers use cancer staging systems to plan treatment and determine prognosis or expected outcomes. In general, early-stage mucosal melanoma is cancer that hasn’t spread from where it started.

Providers use specific staging systems for each type of mucosal melanoma, and the staging details vary widely. Cancer staging can be complicated. If you’re confused or concerned by what you’re hearing, ask your healthcare provider for more information.

How do healthcare providers treat mucosal melanoma?

Mucosal melanoma is a complicated illness. Most of the time, a multidisciplinary team of specialists works together to manage treatment. That team may include specialists in surgical oncology, radiation oncology and medical oncology. Treatments may include:

• Surgery to remove tumors and surrounding tissue. Surgery often depends on tumor location; some tumors are very challenging to remove with surgery.
• Radiation therapy as adjuvant therapy after surgery.

Medical researchers are doing clinical trials for immunotherapy for cancer and targeted therapy for cancer. Clinical trials evaluate treatments to determine if they’re safe and effective. If you have mucosal melanoma, ask your healthcare provider if you’re a candidate for a clinical trial.

What can I expect if I have this condition?

Mucosal melanoma is life-threatening. Healthcare providers use surgery and other treatments to remove tumors and eliminate cancer cells. But mucosal melanoma tumors often come back (recur). If you have mucosal melanoma, you may need additional surgery or other treatment.

What is the prognosis?

Survival rate studies show that overall, about 25% of people with mucosal melanoma were alive five years after diagnosis. Survival rates for people with mucosal melanoma vary widely, even within specific categories:

• Head and neck: On average, studies show that less than 30% of people were alive five years after diagnosis. (Survival rates range from 14% to 48%.)
• Vulvovaginal (vagina and rectum): About 36% of people with this condition were alive five years after diagnosis.
• Anorectal (anus and rectum):About 20% of people with this condition were alive five years after diagnosis.

It’s important to remember that survival rates are estimates based on the experiences of groups of people with a given medical condition. What was true for those people may not be true for you. If you have questions about survival rates, ask your healthcare provider to explain what you may expect given your situation.

How do I take care of myself?

Mucosal melanoma is a life-threatening condition. It often comes back after treatment (recurs). If you have recurring mucosal melanoma, you may want to consider palliative care to help you to manage condition symptoms and treatment side effects.

When should I see my healthcare provider?

While there are several types of mucosal melanoma that affect people in different ways, all mucosal melanoma types typically come back after treatment. Depending on your situation, your provider will establish regular checkups so they can monitor your overall health and watch for recurring issues.

What questions should I ask my doctor?

Here are some questions you may want to ask your healthcare provider:

• What kind of mucosal melanoma do I have?
• What stage is my illness?
• What are my treatment options?
• How will treatments affect me?
• What is my prognosis?

A note from Cleveland Clinic

Mucosal melanoma is a rare cancer that develops in your mucous membrane. Mucous membrane is soft tissue lining the inside of your organs and empty places in your body, like inside your nose. Mucosal melanoma symptoms are similar to other less serious issues. People often don’t recognize changes in their bodies until the cancer has spread. Typically, healthcare providers use a multidisciplinary process to treat mucosal melanoma. Medical researchers are evaluating other treatments, too. If you have this condition, you may want to ask your provider about participating in a clinical trial.