Mucosal melanoma of the head and neck: a population-based study from Slovenia, 1985-2013

Abstract

ObjectivesTo assess the incidence and to review experience with the treatment of mucosal melanoma of the head and neck (MMHN) in Slovenia between 1985 and 2013.MethodsThe National Cancer Registry database and clinical records with outcome data of identified patients treated during the period 1985–2013 in Slovenia were reviewed.ResultsIn a 29-year period, 61 patients with MMHN were identified, representing 0.5 % of all head and neck malignant tumors and 42 % of all mucosal melanomas in Slovenia. 72 % originated in the sinonasal tract and were predominantly (78 %) diagnosed as a local disease. Regional metastases at diagnosis were more frequent in patients with oral/oropharyngeal primary (44 %; sinonasal MMHN 11 %, p = 0.006). Curative intent treatment was given to 48 (79 %) patients. The overall survival (OS) rates at 2 and 5 years for the whole cohort were 43 % and 18 %, respectively, and for the curative intent group 53 % and 24 %, respectively. In the latter group, multivariate analyses showed postoperative radiotherapy (PORT) to be predictive for locoregional control (LRC) (hazard ratios [HR] for surgery with PORT vs. surgery alone: 1.0 vs. 3.9, p = 0.037), whereas only the World Health Organization performance status (HR for grade 0 vs. grade 1 vs. grade >1: 1.0 (p = 0.022) vs. 1.2 (p = 0.640) vs. 7.7 (p = 0.008)) significantly influenced OS.ConclusionsMMHN is a rare tumor with a poor prognosis. Combination of surgery and PORT offers the best prospects for LRC but without improvement of OS. Due to potential toxicity of high-dose RT such treatment is indicated in patients in whom LRC outweighs the risks of serious adverse effects.

The effectiveness of radiotherapy in the treatment of head and neck mucosal melanoma: Systematic review and meta‐analysis

“…As mentioned, there is a range of surgical and radiotherapy techniques that have been employed. 26,27 There is a large degree of heterogeneity in the literature in this regard. We have not given any consideration to the different methodologies that may be employed and have broadly labeled patients as being surgical alone, SRT, or RT, and our analysis does not stratify based on open or endoscopic surgical techniques or based on the dose, fractionation or technique in which RT was administered, which is a limitation of our analysis.…”

“…Another limitation is how we dealt with surgery and radiotherapy as part of our analysis. As mentioned, there is a range of surgical and radiotherapy techniques that have been employed 26,27 . There is a large degree of heterogeneity in the literature in this regard.…”

Open Versus Endoscopic Approach for Sinonasal Melanoma: A Systematic Review and Meta-analysis

“…The 5-year OS rate for SNM ranges from 20% to 55% in the literature based on small retrospective cohort studies. 1,27 Amit et al. performed a review of the literature for sinonasal mucosal melanoma which found recurrence rates ranging from 17% to 82.7% and distance metastasis rates as high as 83%.…”

“…7 The 5-year OS rate for SNM ranges from 20% to 55% in the literature based on small retrospective cohort studies. 1,27 Amit et al performed a review of the literature for sinonasal mucosal melanoma which found recurrence rates ranging from 17% to 82.7% and distance metastasis rates as high as 83%. [1][2][3]5 The high recurrence rates are thought to be secondary to the multifocal nature of the disease and less associated with lymphatic spread.…”

Effect of Radiotherapy Combined With Pembrolizumab on Local Tumor Control in Mucosal Melanoma Patients

“…Historically, melanoma was regarded as being resistant to conventional RT (7), although this aspect remains controversial. Concerning the treatment of mucosal melanoma, a few studies have reported improved local control (LC) with postoperative RT use (8–10). However, the role of RT remained limited before the introduction of immune checkpoint inhibitors (ICIs).…”