Metastatic tumors to the oral region are rare and mostly produced by breast, lung and kidney cancer, but other tumors may be also included [
6]. Bone involvement is much more frequent than soft tissue involvement, and in the latter case lung cancer is the most common primary source. Hirshberg
et al. [
6] reviewed cases of oral metastases reported from 1916 to 1991 and found 157 cases of oral soft tissue metastases, 86 of which had gingival localization. The primary tumors were located in the lung (25.5%), kidney (15.1%), bone (10.4%), breast (9.3%) and liver (8.1%). Yoshii
et al. [
11] estimated that the probability of lung cancer involving a diagnosis of gingival metastasis is about 10% to 20%. Other authors have emphasized that the prognosis of patients with oral metastases is very poor, with a median survival of less than six months, mainly because of the fact that oral metastases are an expression of a multi-metastatic disease [
12]. A recent review of 39 patients with oral metastases confirmed a median survival of 5.2 months without significant differences according to oral localization or to the site of the primary cancer [
13]. In our patient, oral localization was the only metastasis detectable at presentation. To the best of our knowledge, no other similar cases have been described in the literature, and this calls attention to the importance of recognition of metastases to oral soft tissues. Most gingival lesions in patients with prior or current non-oral malignancies are not metastases [
14]. Generally, gingival or oral mucosal metastases extend from mandibular or maxillary lesions and spread beyond the peri-osteum to cause visible gingival or oral mucosal masses [
14]. Therefore, gingival metastases are polypoid or exophytic and highly vascularized, and bleeding is very common [
8‐
10,
15‐
17]. The same characteristics are also displayed by a number of benign lesions, such as pyogenic granuloma (or vascular epulis), peripheral giant cell granuloma (giant cell epulis) or fibrous epulis [
18]. From a clinical point of view, the aspects suggestive of malignancy are only the rapid growth and the propensity for either necrosis or hemorrhage. In these cases, the possibility of metastasis should be kept in mind, and biopsy is mandatory.
In our patient, no other metastases were found; therefore, we planned a multi-modal therapeutic approach with a curative intent. However, the tumor proved intrinsically resistant and highly aggressive. This behavior raises the question whether the poor prognosis of patients with tumors with oral metastases depends on their diffuse spread or on their highly malignant nature. Early detection might be important in metastases from chemosensitive tumors, whereas chemoresistant tumors, such as lung cancer, the present therapeutic strategies are largely ineffective, and oral metastases should be considered as only a negative prognostic factor.