Survival outcomes of mucosal melanoma in the head and neck: case series and review of current treatment guidelines

• Published in: Journal of oral and maxillofacial surgery Vol. 74; no. 9; pp. 1859 - 1871
• Main Authors: Breik, Omar, Dr, Sim, Felix, Mr, Wong, Tim, Mr, Nastri, Alf, A/Prof, Iseli, Tim A., Mr, Wiesenfeld, David, A/Prof
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Aged; Aged, 80 and over; Dentistry; Female; Humans; Male; Melanoma - pathology; Melanoma - surgery; Middle Aged; Mouth Mucosa - pathology; Mouth Neoplasms - pathology; Mouth Neoplasms - surgery; Nasal Mucosa - pathology; Neoplasm Recurrence, Local - pathology; Nose Neoplasms - pathology; Nose Neoplasms - surgery; Practice Guidelines as Topic; Retrospective Studies; Surgery; Survival Rate; sinonasal; oral melanoma; Mucosal melanoma; survival
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2016.03.008

Abstract Introduction Mucosal malignant melanoma of the head and neck (MMHN) is an aggressive and rare neoplasm with poor long-term outcomes. The aim of this study is to evaluate the outcomes from a single institution head and neck multidisciplinary team. Methods Retrospective case series. All MMHN cases from Royal Melbourne Hospital from 1990-2015 were retrospectively reviewed. Patient demographics, age, treatment offered, pathology and outcomes were collected and tabulated and correlated with outcomes. Survival outcomes were calculated via Kaplan-Meier method. Comparison was made between oral and sinonasal melanoma. Results A total of 16 cases were identified. Two were excluded due to inaccessible data. Out of 14 remaining cases, 8 were sinonasal melanomas. Six were oral cavity melanomas. Sinonasal tumor patients presented with epistaxis or visual impairment. Oral melanoma patients presented with pigmented lesions or ulceration. Follow-up ranged from 4 months to 11 years. Two patients developed locoregional recurrences that were successfully re-excised. Six patients died due to distant metastasis despite clear surgical margins. Two patients with sinonasal melanomas died of extensive local disease invading intracranially. One patient died 4 years after diagnosis without disease. There were no failures in the neck. The overall 2-year and 5-year survival rates were 63.3 and 31.7%, respectively by Kaplan-Meier method. The difference in survival between oral and sinonasal melanomas was not statistically significant. Conclusion Despite clear surgical margins, MMHN has a poor prognosis and most deaths are due to distant metastasis. Systemic therapies such as those used in cutaneous melanoma might be used in future for MMHN.