Background and aim: Non-melanoma skin cancers (NMSC) are one of the most prevalent malignancies of the human. Although the morality rate is not high for these cancers, they may cause high morbility for the patients. In addition to the skin type, factors such as sun exposure, head and neck radiotherapy, inappropriate use of sunscreen and cultural changes may increase the incidence of these cancers. The objective of this study was to determine NMSC in Isfahan.Materials and Methods: We used data of the cancer resistery center for performing this study and the incidence of NMSC per 100,000 populations was determined. Results: Overall 1681 cases were registered. The incidence of NMSC was calculated to be 10.67/100,000population. The most common site for BCC and SCC was middle face. Conclusion: NMSC incidence in Isfahan is lower than west countries although this incidence is 10.67/100,000in a year. It means that 5-6 thousand cases of NMSC occur in Iran each year. We can prevent its morbidity and mortality by early correct diagnosis.

Melanoma is a malignant tumor that originates from melanocyte cells. Its oral type is rare. The goal of this investigation was to determine the prevalence of oral malignant melanoma in Iran, as determined by age, sex and location. This research reviewed 623 cases of oral and non-oral malignant melanoma in Immam-Khomeini hospital, Mearaj cancer institute and department of oral pathology of dental faculty, Tehran University of Medical Sciences in a period of 19 years from 1981-1999. The results showed that 54 cases of biopsy lesions were melanoma of oral cavity that included 7.8% of these lesions. The mean age incidence of oral melanoma was 55.5(between 26-86 years). The most prevalent sites were palate (37.1%) and alveolar mucosa (20.4%) and less common sites included floor of mouth, buccal mucosa and tongue.

Dear Editor, Mucosal melanoma of the head and neck (MMHN) region accounts for ~1.3% of all melanomas affecting the body (1). The conjunctiva is most frequently involved, followed by the upper aerodigestive tract. The oral and nasal cavities share almost 48% and 44% of the melanomas occurring in the upper aerodigestive tract. Paranasal sinuses harbor the bulk of the remainder of cases. Rarely are the pharynx and larynx involved (2). Nearly 80-90% of oral mucosal melanomas (OMM) arise from the keratinizing mucosa of the hard palate and maxillary gingiva.  Buccal mucosa, mandibular gingiva, and the floor of the mouth are rather unusual sites (3). The amelanotic version of melanoma constitutes ~13% of all MMHN, which is more than its cutaneous incidence of 1.8-8.1% (4).Case 1The 42-year-old lady presented with an irregular blackish mucosal patch involving the inner surface of the upper lip (Figure 1A). Any pain or tenderness was absent. Only mere discomfort to the part led to its self-localization. Palpably, the mucosa appeared slightly thickened. Clinically, hemangioma and malignant melanoma surfaced as possible differentials. On histopathology: The thinned-out mucosa overlying diffuse sweeps of heavily pigmented tumor cells (Fig. 1B). These epithelioid tumor cells contained abundant cytoplasm, flocked with dense pigment granules that eventually obliterated their cellular details. Nuclei appeared vesicular with prominent nucleoli. Histomorphologically, the diagnosis of malignant melanoma was evident. Simultaneous positron emission tomography (PET) negated any further dissemination of the melanoma. Postoperatively, after a regimen of radiotherapy and chemotherapy the patient was followed up at 6 months interval without any relapse or recurrence.Case 2A 56-year-old man attended the otorhinolaryngology outpatient clinic with a rapidly enlarging left paranasal mass on his face. Computed tomography (CT) delineated a homogeneous solid tumor arising from the maxillary sinus, encroaching and compressing onto the nasal cavity (Fig. 1C). With a primary suspicion of sinonasal carcinoma or lymphoma, a punch biopsy was taken from the mass. Histologically, undifferentiated tumor cells appeared in diffuse sweeps undermining the ulcerated mucosa (Figure 1C, 1D). The polygonal tumor cells bore grossly irregular large nuclei, marked nuclear pleomorphism, frequent intranuclear cytoplasmic pseudoinclusions, vesicular chromatin, prominent nucleoli, and abundant pale eosinophilic cytoplasm (Fig. 1E). From such a dubious histomorphology sinonasal undifferentiated carcinoma, poorly differentiated squamous cell carcinoma (SCC), large B-cell lymphoma and amelanotic form of malignant melanoma posed as closest differentials. To their discrimination, a battery of immunohistochemical (IHC) markers were exercised. Cytokeratin (CK) 5/6, CD 45, and S100 were applied in the primary panel. The tumor cells expressed strong nucleocytoplasmic reactivity with S100, indicative of malignant melanoma (Figure 1F). While the other two reagents stained negatively (Figure 1I, 1J). HMB 45 was applied for confirmation. Tumor cells expressed strong cytoplasmic granular positivity, affirming it as amelanotic melanoma (Figure 1J). PET scan detected widespread dissemination to cervical lymph nodes, brain and lungs. The patient was immediately subjected to combination therapy. Despite this, he died of the disease after 4 months.

Malignant melanoma is a malignant neoplasm of the skin and mucosal tissues, and its behavior is not predictable. Thus, it could metastasize via mysterious routes. Here, we report a rare case of acute abdomen and acute appendicitis which involved metastatic malignant melanoma in a 63-year-old man without a history of previously treated malignant melanoma.

Conjunctival melanoma is an uncommon tumor that is likely to recur and carries an overall mortality rate of approximately 30%. Melanoma   arises from melanocytes, most often in sun-exposed skin. Less commonly, melanoma originates from other tissues such as the uvea, rectum, mouth, respiratory tract, and conjunctiva. Conjunctival melanoma represents only 1.6% of all noncutaneous melanoma. Herein, we reported a case of conjunctival melanoma followed by reviewing the literature to provide an optimal diagnostic approach.