Mucosal melanoma of the nose and paranasal sinuses, a contemporary experience from the M. D. Anderson Cancer Center

Abstract

BACKGROUND: Sinonasal mucosal melanoma is a rare disease associated with a very poor prognosis. Because most of the series extend retrospectively several decades, we sought to determine prognostic factors and outcomes with recent treatment modalities. METHODS: A retrospective chart review of 58 patients treated for sinonasal melanoma at a tertiary cancer center between 1993 and 2004. The patients were retrospectively staged according to the sinonasal American Joint Committee on Cancer (AJCC) staging system. Demographic, clinical and pathological parameters were identified and correlated with outcomes. RESULTS: There were 35 males and 23 females with a median age of 63 years; 56 patients were treated surgically and 33 received radiation therapy. According to Ballantyne's clinical staging system, 88% of the patients presented with stage I (local) disease. Classification by the AJCC staging classified yielded 27% of the patients with T1, 33% with T2, 21% with T3, and 19% with T4. T-stage and the degree of tumor pigmentation were associated with a worse survival (P ¼ .0096 and P ¼ .018, respectively), while pseudopapillary architecture was associated with a higher locoregional failure (P ¼ .0144). Postoperative radiation therapy improved locoregional control when a total dose greater than 54 Gy was used (P ¼ .0215), but did not affect overall survival. CONCLUSIONS: Tumor stage according to sinonasal AJCC staging system is an effective outcome predictor and should be the staging system of choice. Postoperative radiation therapy improves locoregional control when a higher dose and standard fractionations are used. Histological features such as pigmentation and pseudopapillary architecture are associated with worse outcome. Cancer 2010;116:2215-23.

Sinonasal Mucosal Melanoma: A Clinicopathological Review

“…Compared to their oral counterpart sinonasal melanoma have lower rate of regional spread and more commonly present as ulcerative or polypoid morphology, pseudopapillary growth pattern with necrosis and a tendency towards perineural invasion. [12] Mucosal melanoma may be suspected from their gross appearance presenting as a large polypoidal and bulky mass which may or may not contain melanin pigment. Microscopically, these tumours usually show lymphoid infiltrate at the periphery which may be due to immune response.…”

“…Studies suggest that the presence of mitotic figure (>10/10 HPF) may be associated with worse clinical outcome. [6,12] The differential diagnosis of sinonasal mucosal melanoma may include undifferentiated carcinoma, lymphoma, plasmacytoma, rhabdomyosarcoma and olfactory neuroblastoma. [6] which may not be reliably differentiated on histology.…”

“…This staging system is simple and approximately 70-95% of mucosal melanoma are found to present as a Stage I localized disease. [12] However, such a large portion falling in one category limits the prognostic significance of the Ballantyne staging system.…”

Radiation Therapy for Melanoma

“…A majority of the data pertains to head and neck mucosal melanomas and the addition of postoperative RT offers a local control benefit. The local recurrence rates with adjuvant radiation ranges from 15 to 30% (27)(28)(29). Despite the local control benefit of adjuvant radiation, there is no impact on overall survival, likely due to the high risk of systemic relapse (28)(29)(30)(31)(32)(33).…”

Primary sinonasal mucosal melanoma – Case report and literature review

“…One study has shown that association of targeted therapies and immunotherapy with checkpoint inhibitors appears to show the highest response rates and longest progression-free survival in advanced cases 8 . Despite a better knowledge of this tumor, the 5-year overall survival remains poor, does not exceed 40% in any of the published studies and usually it is diagnosed in an advanced stage of disseminated disease 9 .…”