Prognostic Factors for Malignant Melanoma of the Squamous Mucosa of the Head and Neck

Abstract

Primary malignant melanomas of the squamous mucosa of the head and neck are rare. To learn more about the prognostic significance of various histologic parameters we examined the pathologic features of squamous mucosa from 40 patients seen at a single institution and correlated them with clinical outcome. Follow-up information was available on 37 patients. Thirty-five were treated with surgical resection and two were treated with radiotherapy. Twenty-six were dead at follow-up. Twenty-one of them died of disease. The interval between diagnosis and death ranged from 1 month to 16.5 years (median survival, 2.4 years). Eleven patients were alive at 4 months to 19.5 years after the diagnosis: six of them with disease and five of them free of disease (mean follow-up, 3.5 years). Predictors of poor survival by univariate analysis were the presence of vascular invasion (overall survival, p = 0.007; disease-specific survival, p = 0.01), a polymorphous tumor cell population (overall survival, p = 0.007; disease-specific survival, p = 0.008), and necrosis (overall survival, p = 0.007; disease-specific survival, p = 0.056). However, because these three parameters were associated with each other, none of them remained of independent predictive value for outcome by multivariate analysis. No prognostic significance was found for tumor thickness, level of invasion, ulceration, mitotic index, or nerve/nerve sheath involvement. Thus, the histologic parameters relevant for the prognosis of squamous mucosa differ significantly from those of cutaneous melanomas.

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Mucosal Melanomas

“…Thus, despite easier visualization of the oral cavity, presentation at a late stage remains common. Men may be slightly more affected by oral MM than women [19][20][21].…”

“…Pagetoid spread into the overlying epithelium may also occur (<20%). In oral MM, the rate of finding an in situ component is up to 90% [21]. This observation may result from better oriented tissue sections and smaller tumor size at presentation than sinonasal tract primaries.…”

Prognostic Significance of Regulators of Cell Cycle and Apoptosis, p16INK4a, p53, and bcl-2 in Primary Mucosal Melanomas of the Head and Neck

“…undifferentiated tumor cell morphology, vascular invasion, tumor necrosis and deep tissue invasion [17,21]. Now we extend our study to identify molecular predictors of prognosis.…”

“…MART-1/Melan A (A103), glycoprotein 100 (HMB45), tyrosinase (T311), S100 protein, microphthalmia-associated transcription factor (D5) as published elsewhere [15]. This database has been used for clinical, pathologic, and protein expression profiling of oral and sinonasal melanomas in the past [16][17][18][19][20][21]. The current study includes a subset of cases where formalin-fixed paraffin-embedded (FFPE) tumor tissue was available for additional study of prognostic markers.…”

Mélanomes de la cavité buccale : présentation de 3 cas

“…S'il est détecté plus précocement, au stade intra-épithélial (mélanome in-situ) ou au stade initial de l'invasion du chorion, il est plus aisé de faire la distinction entre les diverses variétés, rendant le pronostic quelque peu différent bien que toujours sombre. Certains auteurs considèrent qu'il n'y a aucune corrélation entre les éléments précités et le pronostic de la tumeur [11,12]. Exceptionnellement, il peut s'agir d'une métastase buccale d'un mélanome cutané (en particulier dans la région de l'amygdale et de la base de la langue) ou d'une extension à la cavité buccale d'un mélanome des fosses nasales ou des sinus maxillaires.…”