Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 112570

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : ZD01 - ZD03 Full Version

Amelanotic Malignant Melanoma of Buccal Mucosa: A Case Report

Published: November 1, 2022 | DOI:
Vidyalakshmi Santhanam, Vezhavendhan Nagaraja, Santhadevy Aroumugam, R Suganya, Shivaramakrishnan Muthanandham

1. Professor, Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Puducherry, India. 2. Professor, Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Puducherry, India. 3. Professor, Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Puducherry, India. 4. Reader, Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Puducherry, India. 5. Reader, Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Puducherry, India.

Correspondence Address :
Dr. Vidyalakshmi Santhanam,
Professor, Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Puducherry, India.


Amelanotic melanoma is an atypical variation from pigmented malignant melanoma. The clinical lack of pigment compromises the physician’s clinical diagnosis of the lesion. Presence of certain features like red hair, freckles, photosensitivity, previous history or family history predispose the possibility of occurrence of amelanotic melanoma. As the name suggests, the lesions lack pigmentations clinically and mimic many benign and malignant lesions which can be life threatening and thus, cause a diagnostic challenge. Hence, clinicians are expected to have a high suspicion on such lesions, and also judiciously employ biopsy, thus eluding the possibility of emerging of lethal lesions. About 50% of head and melanomas occur in the oral cavity. Of all the melanomas, 2% are amelanotic and majority of them occur in oral cavity. These lesions pose a greater degree of threat, because of the possibility of delayed diagnosis. The timely clinical and laboratory diagnosis favours the patient prognosis. No specific aetiologic factors or risk factors have been recognised for oral melanomas. Hereby, the authors present a case of 60-year-old female patients with ulceroproliferative growth in the left cheek region, which was provisionally diagnosed as malignant ulcer, immunohistochemical investigation of the biopsied sections revealed the diagnosis of amelanotic melanoma. The present case report illustrates the need of addition of a panel of Immunohistochemistry (IHC) markers in the routine diagnosis. The application of such panels avoid the delay in diagnosis and scale-up the prognosis.


Neoplasm, Neuroendocrine tumours, Neuroectodermal tumours

Case Report

A 60-year-old female patient, presented with chief complaint of growth in left cheek region for a period of one month. Patient gave a history of betel nut chewing for 15 years, without any relevant medical history. On extraoral examination, gross facial asymmetry was noticed. Swelling was noticed in the lower third of the face of size 2×2 cm, extending to the inferior border of the mandible. On examination, the left submandibular lymph node (3×4 cm) and left cervical lymph node (2×2 cm) were palpable, hard, non tender and fixed. On intraoral examination, ulceroproliferative growth in the left cheek region of size 2.5×2.5 cm was noticed. The growth was in relation to 38 region, with its anterior and posterior extension to the buccal vestibule of 37 and pterygomandibular raphe, respectively. Medially, the lesion involved the lingual aspect of 38 impinging on the occlusal plane. The margins were irregular with everted edges. The surface was corrugated and bleeding upon probing was noticed (Table/Fig 1). The swelling was non tender on palpation. Provisional diagnosis of malignant ulcer was attained. Squamous cell carcinoma, melanoma and mucoepidermoid carcinoma were considered in the clinical differential diagnosis.

The patient was then, subjected to incisional biopsy. Upon microscopic examination, the sections revealed a highly cellular connective tissue with a superficial stratified squamous parakeratinised epithelium of varied thickness. The epithelium showed moderate amount of cellular atypia. The underlying connective tissue was dominated by a high degree of cellularity. Numerous epithelioid cells were found in islands and sheets. Sheets of hyperchromatic cells with abundant eosinophilic cytoplasm and large peripherally placed nucleus with bizarre shapes were noticed. Subepithelially, hyperchromatic cells with dense eosinophilic cytoplasm exhibiting cellular and nuclear pleomorphism arranged in numerous small islands resembling theques, were also noticed. Numerous mitotic figures were noticed. The neoplastic cells also, found to exhibit spindle transformation in the periphery of the lesion. [Table/Fig-]2a,b,c. Diagnosis of undifferentiated carcinoma was given. Poorly differentiated squamous cell carcinoma, high-grade mucoepidermoid carcinoma, malignant melanoma and metastatic tumour should be ruled out, since they poise a histopathological similarity. The tissue was then immunohistochemically analysed for the panel of markers: Pan cytokeratin, Vimentin, S-100 protein, Human Melanoma Black (HMB)-45, Desmin, Muscle Specific Actin (MSA), CD34, LCA. Strong Positive immunoreactivity was noticed for vimentin, S-100, and HMB-45. S-100 and HMB-45 positivity revealed the cells, which were of neuroectodermal origin, more precisely melanocytes (Table/Fig 3). The final diagnosis of primary amelanotic melanoma plasmacytoid variant was made. The lesional tissue was surgically resected with wide margins. Patient had a symptom free, follow-up period for one and a half year.


Melanoma is less commonly occurring deadly mucocutaneous malignancy. About 90% of melanoma arises from skin surface and around 1-2% occur in oral mucous membrane (1). There is a strong coincidence between the mutation status and the clinicopathological subtypes of melanoma which supports the existence of biologically distinct types of melanoma, thereby, presenting a diagnostic challenge. More than half of the lesions arise de novo. Age and susceptibility to chronic accumulated sun exposure, familial history and presence of a potential precursor are the major risk factors of melanoma (2). About 50% of the head and neck melanomas occur in the oral cavity. Less than 2% of all melanomas are amelanotic, and majority of them occur in the oral cavity perplexing the clinical diagnosis (1),(3).

The primary mucosal melanomas of the oral cavity are relatively rare compared to the head and neck melanomas and from time to time, they tend to manifest without melanin pigmentation (4). Oral 2melanomas clinically manifest as nodular, macular and ulcerative lesions with or without pigmentations [5,6]. Oral malignant melanomas can also present as multiple nodular lesions in the palate (7). The diagnosis of amelanotic melanoma is quiet challenging and portray a clinical resemblance to quite a few benign malignant mucosal lesions. The specific cause for lack of pigmentation is unclear. Speece proposed in his work that, the deficiency of tyrosine is associated with the lack of pigmentation (8).

Some authors believe that, melanin quantity is insufficient to be seen histopathologically, which is further substantiated by electron microscopical demonstration of melanosomes in amelanotic melanoma. Oral melanoma is usually asymptomatic, and aetiology is associated with smoking tobacco, pre-existing nevi, ill-fitting dentures and amalgam tattoo (9). The prognosis of amelanotic melanoma is poorer than its pigmented counterpart, attributed to the absence of pigment, not favouring an early diagnosis. The prognosis is about 20% and 58% for amelanotic and melanotic melanoma, respectively for a survival rate of three years (10). Amelanotic melanoma presents as a metastatic tumour in the lung from the primary melanoma in oral cavity (11). The present case presented an ulceroproliferative growth in the posterior buccal mucosa with no evidence of pigmentation. Patient gave a clinical history of tobacco and betel nut chewing for 15 years, favouring the clinical diagnosis of squamous cell carcinoma.

Microscopically, melanoma presents itself in three patterns. In-situ intraepithelial radial growth pattern, invasive vertical growth pattern (30%) involving epithelium and connective tissue, combination of first and second pattern. Presence of melanin pigment, dysplastic melanocytes facilitate the diagnosis of melanoma. However, when the lesion lacks pigmentation clinically, malignancy of oral epithelium, keratoacanthoma, and granulomatous lesions should be considered in the differential diagnosis. Melanoma microscopically is confused with a wide spectrum of tumours of epithelial, haematological, neurological and mesenchymal origin (12). The histopathological differential diagnosis is considered based on the morphological appearance of the cell. Spindle cell malignant tumour (leiomyosarcoma, angiosarcoma, spindle cell carcinoma) round cell tumour (lymphoma and neuroendocrine tumour) clear cell tumour (renal cell carcinoma) and epithelioid malignant tumour (squamous cell carcinoma) should be considered for microscopic differential diagnosis. In the present case, the authors noticed atypical epithelioid cells and bizarre appearing hyperchromatic cells arranged in the form of islands, sheets and theques. The diagnosis of undifferentiated carcinoma was arrived. However, to rule out the origin of the tumour, immunohistochemistry was opted.

Pan melanoma cocktail comprise HMB-45 (Human Melanoma Black), MART-1 (Melanoma-associated antigen recognised by T-cells), tyrosinase, S-100 are effective in diagnosis of amelanotic melanoma (13),(14). S-100 is highly sensitive but not a specific marker, HMB-45, which is a marker of premelanosome proved to be good enough in detecting hypopigmented melanocytes. MART -1/Melan-A (Antigen of Melanocytes of Cytotoxic T-cells), sensitivity of this antigen is greater than HMB-45 but its specificity is almost same and less sensitive in spindle cell melanomas (14). MAGE-1 (Melanoma Associated Antigen) Tyrosinase may be very useful in diagnosis when HMB-45 is negative. Pan melanoma cocktail is 98% sensitive with all melanomas with 60% sensitivity in desmoplastic melanomas (15). Vimentin, S-100 and HMB-45 positivity was observed in the present case. In the present case, the melanocytes predominantly presented itself in bizarre shapes and arranged in the form of theques and islands. The atypical cells nowhere in the sections expressed pigmentation. The lesional cells had large eosinophillic cytoplasm with peripherally placed nucleus resembling plasma cells. Hence, the final diagnosis of primary amelanotic melanoma-plasmacytoid variant was given after thorough examination of the patient, for similar lesions, elsewhere in the body.


Hypopigmented lesions are clinically deceptive, thereby, hindering the pace of diagnosis and further favouring the disease progress. Melanoma cells in tissue sections takes up various shapes ranging from round, polyhedral, spindle, fusiform, epitheliod masquerading other malignancies. The melanin pigment may not be traced frequently in cases of amelanotic melanoma, like its counterpart. Very few traces of melanin pigment can be either found in the cytoplasm of tumour cells and phagocytes and extracellular areas. Pan melanoma cocktail comprising HMB-45, MART-1, tyrosinase, S-100 are greatly helpful in the diagnosis of melanomas, that lack pigmentation both in clinical and tissue sections. The authors, would like to emphasise the significance of reach and the availability of the IHC panel of markers in the histopathological laboratory, as one among the routine primary diagnostic markers.


Shetty A, Kumar SA, Geethamani V, Rehan M. Amelanotic melanoma masquerading as a superficial small round cell tumor: A diagnostic challenge. Indian J Dermatol. 2014;59(6):631. [crossref] [PubMed]
Elenitsas R, Johnson BL, Xu X, Murphy GF. Lever’s histopathology of the skin. Wolters Kluwer; 2009.
Adisa AO, Olawole WO, Sigbeku OF. Oral amelanotic melanoma. Ann Ib Postgrad Med. 2012;10(1):06-08.
Feller L, Khammissa RAG, Lemmer J. A Review of the aetiopathogenesis and clinical and histo-pathological features of oral mucosal melanoma. Scientific World Journal. 2017;2017:9189812. [crossref] [PubMed]
Esmaeili M, Hosseini A. Amelanotic primary malignant melanoma of the maxilla: A case report. J Arch Mil Med. 2017; 5(1):e13225. [crossref]
Gong HZ, Zheng HY, Li J. Amelanotic melanoma. Melanoma Res. 2019;29(3):221-30. [crossref] [PubMed]
Limongelli L, Cascardi E, Capodiferro S, Favia G, Corsalini M, Tempesta A, et al. Multifocal amelanotic melanoma of the hard palate: A challenging case. Diagnostics (Basel). 2020;10(6):424. [crossref] [PubMed]
Rimal J, Kasturi DP, Sumanth KN, Ongole R, Shrestha A. Intra-oral amelanotic malignant melanoma: Report of a case and review of literature. Journal of Nepal Dental Association. 2009;10(1):49-52.
Saghravanian N, Pazouki M, Zamanzadeh M. Oral amelanotic melanoma of the maxilla. J Dent (Tehran). 2014;11(6):721-25.
Aziz Z, Aboulouidad S, Bouihi ME, Hattab NM, Chehbouni M, Raji A, et al. Oral amelanotic malignant melanoma: A case report. Pan Afr Med J. 2020;37:350. [crossref] [PubMed]
Matsuoka K. Oral malignant melanoma detected after resection of amelanotic pulmonary metastasis. Int J Surg Case Rep. 2013;4(12):1169-72. [crossref] [PubMed]
Panda S, Dash S, Besra K, Samantaray S, Pathy PC, Rout N, et al. Clinicopathological study of malignant melanoma in a regional cancer center. Indian J Cancer. 2018;55(3):292-96. [crossref] [PubMed]
Kawasaki G, Yanamoto S, Yoshitomi I, Mizuno A, Fujita S, Umeda M, et al. Amelanotic melanoma of the mandible: A case report. Oral Science International. 2011;8(2):60-63. [crossref]
Cheung WL, Patel RR, Leonard A, Firoz B, Meehan SA. Amelanotic melanoma: A detailed morphologic analysis with clinicopathologic correlation of 75 cases. J Cutan Pathol. 2012;39(1):33-39. [crossref] [PubMed]
Xu X, Chu AY, Pasha TL, Elder DE, Zhang PJ. Immunoprofile of MITF, tyrosinase, melan-A, and MAGE-1 in HMB45-negative melanomas. Am J Surg Pathol. 2002;26(1):82-87.[crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/57823.17023

Date of Submission: May 18, 2022
Date of Peer Review: Jun 29, 2022
Date of Acceptance: Oct 08, 2022
Date of Publishing: Nov 01, 2022

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: May 19, 2022
• Manual Googling: Jul 21, 2022
• iThenticate Software: Oct 05, 2022 (4%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)