An unusual pigmented tonsil neoplasm presenting to Head & Neck Clinic: a case report and literature review of primary tonsillar malignant mucosal melanoma

Primary mucosal melanoma of the tonsil is rare, with 27 reported cases. Careful diagnosis is necessary, as the tonsil is more often a site of metastatic melanoma from a cutaneous primary tumour. In this report, we present a case of primary right tonsillar mucosal melanoma with widespread metastasis in a 31-year-old man who presented with a 3-month history of enlarging neck lumps. On examination, he had cervical lymphadenopathy and a pigmented, vascular lesion of his right tonsil, which was diagnosed as melanoma following investigation. He had widespread metastases upon presentation, and is currently undergoing palliative immunotherapy. Owing to the aggressive behaviour, late presentations and lack of effective treatment to cure mucosal melanomas, they have a poor prognosis. Treatment involves wide local excision in local disease, and immunotherapy as the first-line for metastatic disease.