粘膜黑色素瘤是一种侵袭性恶性肿瘤，不同于头颈部常见的皮肤黑色素瘤，占所有恶性黑色素瘤的 1%<1%。粘膜黑色素瘤的发病机制尚不清楚。皮肤黑色素瘤中常见的靶向突变（例如 BRAF 和 NRAS 基因）在粘膜黑色素瘤中的发生率较低。粘膜黑色素瘤具有与皮肤黑色素瘤不同的突变模式。切缘阴性手术是粘膜黑色素瘤的一线治疗方法，全身治疗尚不明确。 Talimogene laherparepvec 是一种溶瘤病毒免疫疗法，已被美国食品和药物管理局批准用于治疗晚期恶性皮肤黑色素瘤，具有局部治疗效果。粘膜黑色素瘤最初被排除在 talimogene laherparepvec 的初始 III 期临床试验之外。我们介绍了一名 40 多岁的白人女性患者的病例，她既往有系统性红斑狼疮、硬皮病和雌激素受体阳性浸润性导管乳腺癌病史。双侧乳房切除术后，患者被发现硬腭患有 BRAF 阴性粘膜黑色素瘤，并伴有软腭跳跃性病变。由于存在跳跃性粘膜病变以及预期的缺陷和游离皮瓣重建手术的需要，因此考虑了非手术治疗。该患者被转诊至肿瘤内科，基于患者复杂的病史以及免疫治疗可能使她既往自身免疫性疾病恶化的风险，选择局部注射talimogene laherparepvec作为其粘膜病变的主要治疗方法。尽管 talimogene laherparepvec 被批准用于治疗皮肤黑色素瘤，但有关 talimogene laherparepvec 在粘膜黑色素瘤中使用的数据有限。患者在局部注射后，在原发灶和跳跃病灶处均获得了完整的局部肿瘤反应。她没有任何副作用，并且在治疗期间保持了高质量的生活。© 2024。作者。

Mucosal melanoma, an aggressive type of malignancy different from the cutaneous melanomas commonly seen in the head and neck region, represents < 1% of all malignant melanomas. The pathogenesis of mucosal melanoma is unknown. Targetable mutations commonly seen in cutaneous melanoma, such as in the BRAF and NRAS genes, have a lower incidence in mucosal melanoma. Mucosal melanoma carries a distinct mutational pattern from cutaneous melanoma. Surgery with negative margins is the first-line treatment for mucosal melanoma, and systemic therapy is not well defined. Talimogene laherparepvec, an oncolytic viral immunotherapy, is United States Food and Drug Administration approved for the treatment of advanced malignant cutaneous melanoma, with local therapeutic benefits. Mucosal melanoma was initially excluded from talimogene laherparepvec's initial phase III clinical trial.We present the case of a white female patient in her 40s with past medical history of systemic lupus erythematous, scleroderma, and estrogen-receptor-positive invasive ductal breast carcinoma. Following a bilateral mastectomy, the patient was found to have BRAF-negative mucosal melanoma of her hard palate with a soft palate skip lesion. Owing to the presence of a skip mucosal lesion as well as the anticipated defect and need for free-flap reconstructive surgery, nonsurgical management was considered. The patient was referred to medical oncology, where-based on the patient's complicated medical history and the risk of immunotherapy possibly worsening her prior autoimmune diseases-local talimogene laherparepvec injections were chosen as the primary therapy for her mucosal lesions. Though talimogene laherparepvec is approved for the treatment of cutaneous melanoma, there are limited data available on the use of talimogene laherparepvec in mucosal melanomas.The patient had a complete local tumor response at both the primary lesion as well as the skip lesion with the local injections. She had no side effects and maintained a high quality of life during treatment.© 2024. The Author(s).