Clinicopathological Features and Prognosis of Sinonasal Mucosal Malignant Melanoma: A Retrospective Study of 83 Cases in a Chinese Population

Abstract

Aims: Sinonasal mucosal malignant melanoma (SNMMM) is a rare disease. The aim of the present study was to describe its clinicopathological features and prognosis in a Chinese population. Methods: Data on 83 SNMMM patients were collected and analyzed. A survival analysis was performed using the Kaplan-Meier method and a log-rank test. Results: The most common presenting symptoms of SNMMM were nasal obstruction, epistaxis, and bloody rhinorrhea. Histopathologically, 38 cases (45.78%) were amelanotic. Five cell types (epithelioid, undifferentiated, plasmacytoid, spindle, and clear) were identified. Positive staining for human melanoma black-45 and Melan-A was diagnostic of SNMMM. Advanced age, multiple tumor sites, and amelanotic-type SNMMM indicated a worse outcome (p = 0.008, p = 0.009, and p = 0.013, respectively). Neither adjuvant therapy nor the tumor stage was associated with overall survival. Conclusions: SNMMM is an uncommon disease with atypical symptoms. Its histopathological appearance is variable, especially in the amelanotic type. Thus, immunohistochemistry is important in the diagnosis, and it should be performed according to the histology.

Malignant Melanoma Arising in Association with Sinonasal Melanosis: A Case Report and Review of the Literature

“…The mixed type is most ed cells in the seromucinous glands. Most prior studies have not described pigmented cells in the seromucous glands as seen in our case [15][16][17][18][19][20][21]. The luminal lining cells contained not only melanin pigment (positive Fontana-Masson reaction) but also were immunoreactive for HMB-45, S-100 protein and melan A suggesting the production of melanin in these cells.…”

“…common followed by the epithelial type [15]. Sinonasal melanomas frequently express S-100 protein, HMB-45 and melan A [15,17]. The melanoma cells in our case were predominately oval to polygonal in shape (epithelioid) and were S-100 protein, HMB-45 and melan A reactive.…”

“…Mucosal melanomas are rare and are reported to have a more aggressive behavior than their cutaneous counterparts [12][13][14][15][16][17]. Sinonasal melanomas appear to be the most common of the head and neck mucosal melanomas [12,18].…”

“…Sinonasal melanomas appear to be the most common of the head and neck mucosal melanomas [12,18]. Sinonasal melanomas arise in a variety of sites with approximately 55% arising in the nasal cavity, 12% to 44% in the lateral wall, 8% to 20% in the nasal septum and 10% to 50% in a single sinus [15,19,20]. Melanomas may take a variety of cell shapes with epithelioid, plasmacytoid, undifferentiated, spindle cell, clear cell and mixed types being reported [15,17,21].…”

“…The patient denied epistaxis, but did report small amounts of hemoptysis daily. common followed by the epithelial type [15]. Sinonasal melanomas frequently express S-100 protein, HMB-45 and melan A [15,17].…”