Case presentation
In November 2018, a 58 years-old-woman with BRAF-mutated metastatic melanoma, treated at the Immunotherapy Unit of Our Institute, was referred to our Oral Pathology Outpatient Clinic. During a regular follow-up visit, the patient reported that she was experiencing severe pain in the oral cavity since four months due to a non-healing alveolus, after the extraction of the lower right third molar. During this time, the patient had been treated by her dentist for an alveolar osteitis (AO, dry sockets) with one-week cycle of Amoxicilline + Clavulanic Acid (2.25 + 0.75 grams/day per os) and Chlorexidine 0.2% mouthwash daily socket irrigation. She referred that she had repeated this therapy three times during those months, continuing Chlorexidine 0.2% mouthwash daily socket irrigation among the antibiotic cycles. She referred that, occasionally, she also underwent application of zinc oxide eugenol in her alveolus. Furthermore, the patient had used Chlorexidine 0.12% mouth rinse since day before the extraction. Every treatment tried up until now had been unsuccessful. She had no extra-oral sign of swelling nor of ongoing abscess. Intraorally, clinical inspection confirmed the presence of a non-healed alveolar socket; the bottom and the walls of the alveolus were clearly visible, made of non-vascularized non-suppurated bone, surrounded by swollen mucosa (figure 1).