Intraoral desmoplastic melanoma requiring radical multidisciplinary resection and free flap reconstruction: case report and literature review.

Desmoplastic melanoma (DM) is a rare variant of malignant melanoma characterized by spindle cell proliferation within dense collagenous stroma and atypical immunohistochemical profile. Intraoral involvement is exceedingly uncommon and poses diagnostic and therapeutic challenges. We report the case of a male patient in his fourth decade presenting with enlarging right orofacial mass associated with extensive soft tissue and osseous infiltration. Histopathological evaluation revealed infiltrative spindle cell neoplasm with focal melanin pigment and limited expression of conventional melanocytic markers, requiring integrated diagnostic approach. The patient underwent radical en bloc resection followed by immediate reconstruction using anterolateral thigh free flap. Adjuvant systemic therapy was not administered; however, it was evaluated within multidisciplinary tumor board. At 12-month follow-up, no locoregional recurrence was observed. This case underscores diagnostic complexity of intraoral DM and highlights importance of multidisciplinary oncologic approach in optimizing management outcome.