Head Melanoma Research Articles

A Prognostic Model for Cancer-Specific Survival Among Patients with Nodular Melanoma in Head and Neck.

This study aims to evaluate the correlation between risk factors and treatment methods affecting nodular melanoma (NM) in the head and neck, as well as cancer-specific survival (CSS), and provide personalized predictive tools for clinical physicians. The retrospective study data of 1848 patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All variables were included in the correlation analysis using the Spearman method. Significant prognostic factors were extracted and integrated through Cox risk regression analysis to construct a nomogram. To assess the performance of the nomogram, Harrell's concordance index (C-index) and a receiver operating characteristic (ROC) curve analysis were employed. Spearman's correlation analysis revealed a positive correlation between radiotherapy and lymph node metastasis, whereas chemotherapy showed a stronger association with distant metastasis. However, Cox risk regression analysis demonstrated that Mohs surgery and wide excision with margins exceeding 1 cm yielded substantial therapeutic advantages. Five independent risk prognostic factors (Breslow thickness, ulceration, N classification, M classification, and surgery type) were employed to construct a nomogram. The C-index for this nomogram was 0.713 for the training set and 0.720 for the validation set. In the training set, the 3-, 5-, and 8-year areas under the curve (AUCs) for CSS were 0.752, 0.723, and 0.720, whereas the validation set's AUCs were 0.754, 0.763, and 0.760, respectively. Calibration curves indicated the nomogram's strong discriminative ability for predicting CSS. In this study, we identified independent prognostic factors for patients with NM in head and neck and developed a relatively accurate model to predict the survival probability of them, which could contribute to the tumor assessment and clinical decision-making. 3 Laryngoscope, 134:3611-3619, 2024.

Characteristics of tumor infiltrating lymphocytes in sinonasal mucosal melanoma and prognosis for patients

The significance of tumor infiltrating lymphocytes (TILs) in melanoma has been studied for a long time, but, to date, there has been insufficient research on TILs in sinonasal mucosal melanoma. The purpose of this study was to analyze the correlation between TILs and prognosis for Chinese patients with sinonasal mucosal melanoma, and to clarify the significance of TILs in prognosis. As a retrospective cohort study, 44 cases of malignant melanoma in head and neck mucosa were studied by immunohistochemical staining. The correlation between TIL classification (immune cell infiltration types), CD3, CD4, CD8, CD20, CD45, CD56, and CD68 positive cells, disease progression and prognosis for survival was analyzed. By pairing various factors, RNA sequencing and xCell analysis were performed in another 8 patients with different prognoses to further verify the expression of immune cell subsets in these patients. Immunohistochemistry and cell counting showed that the TIL classification and content of CD3, CD4, CD8, CD20, CD45, CD56, and CD68 positive cells were independent factors influencing progression-free survival, but there was no clear correlation with overall survival. RNA sequencing and xCell immunocyte analysis further confirmed the role of TILs in the prediction of disease progression. CD8+ T cells and natural killer T cells were highly expressed in patients with no disease progression, while Th2 T cells, macrophages and M2 macrophages were highly expressed in patients with disease progression. TILs can be used to predict the prognosis for patients with sinonasal mucosal melanoma. Different degrees and distributions of immune cell infiltration influence disease progression in patients with sinonasal mucosal melanoma. Patients with a diffuse distribution and a high density of infiltrating cells have a better prognosis. A high expression of CD8+ T cells and natural killer T cells, which have an immune killing effect, are beneficial in controlling progression of the disease.

Comparing the characteristics and predicting the survival of patients with head and neck melanoma versus body melanoma: a population-based study

BackgroundPrevious studies reported cutaneous melanoma in head and neck (HNM) differed from those in other regions (body melanoma, BM). Individualized tools to predict the survival of patients with HNM or BM remain insufficient. We aimed at comparing the characteristics of HNM and BM, developing and validating nomograms for predicting the survival of patients with HNM or BM.MethodsThe information of patients with HNM or BM from 2004 to 2015 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The HNM group and BM group were randomly divided into training and validation cohorts. We used the Kaplan-Meier method and multivariate Cox models to identify independent prognostic factors. Nomograms were developed via the rms and dynnom packages, and were measured by the concordance index (C-index), the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and calibration plots.ResultsOf 70,605 patients acquired, 21% had HNM and 79% had BM. The HNM group contained more older patients, male sex and lentigo maligna melanoma, and more frequently had thicker tumors and metastases than the BM group. The 5-year cancer-specific survival (CSS) and overall survival (OS) rates were 88.1 ± 0.3% and 74.4 ± 0.4% in the HNM group and 92.5 ± 0.1% and 85.8 ± 0.2% in the BM group, respectively. Eight variables (age, sex, histology, thickness, ulceration, stage, metastases, and surgery) were identified to construct nomograms of CSS and OS for patients with HNM or BM. Additionally, four dynamic nomograms were available on web. The internal and external validation of each nomogram showed high C-index values (0.785–0.896) and AUC values (0.81–0.925), and the calibration plots showed great consistency.ConclusionsThe characteristics of HNM and BM are heterogeneous. We constructed and validated four nomograms for predicting the 3-, 5- and 10-year CSS and OS probabilities of patients with HNM or BM. These nomograms can serve as practical clinical tools for survival prediction and individual health management.

Does morphology have real impact on local and distant recurrences in head and neck cutaneous melanoma?

Introduction. The term “local recurrence” is usually understood as regrowth of a tumor after surgical treatment. The regrowth appears within 3–5 cm from postoperative cicatrix. The causes for such prolonged tumor growth or recurrence of patients with cutaneous melanoma are nonradical surgical treatment as well as satellite or transit metastases that were not removed in-block with primary tumor. A great number of clinical researches, aimed at examination of melanoma, its patterns, anatomical criteria and features of clinical course, gave an opportunity to separate satellite or transit metastases into an independent group. Such metastases are realized inside or subdermally, up to 2 cm or more than 2 cm from the primary tumor, yet, not reaching the location of the first regional barrier.The aim of the study is to define influence of the main prognostic factors such as tumor thickness according to Breslow, the level of invasion according to Clark and the presence of ulceration on the frequency of local recurrence with cutaneous melanoma of head and neck.Materials and methods. The research involved 174 patients with cutaneous melanoma of head and neck (1995–2014). According to our index of contraction of a skin flap (median 30 %) the true borders of resection were clearly defined within all the patients. Thereby, 3 groups were identified with the following resection margin: 1.0 cm, where followed-up treatment results were analyzed.Results. Progression-free survival didn’t correlate with the size of surgical resection margins. The survival rates were the best with the lowest resection margin under 0.5 cm (77.3 %) and the worst with the highest resection margin more then 1.0 cm (38.7 %). That means that the treatment results don’t depend on the width increase of tumor resection margin.Conclusions. We consider that clear surgical margins for any thickness of cutaneous melanoma of head and neck should be as follows: 4 mm – 0.72 mm (p = 0.016). In our work, the influence of the main prognostic factors, such as tumor thickness according to Breslow, level of invasion according to Clark and ulceration on the frequency of head and neck cutaneous melanoma local recurrences had no impact.

Matched analysis of the prognosis of amelanotic and pigmented melanoma in head and neck

Background: The prognosis of mucosal melanoma is poor, and the difference in clinical prognosis between patients with and without pigment needs further study.Aim: To analyze data with head and neck mucosal melanoma, and compare the prognosis of patients with and without pigment.Material and methods: The patients of amelanotic melanoma were matched with pigmented type according to age, sex, stage, location of disease, treatment history, tobacco and alcohol history. The Kaplan–Meier and Cox proportional risk regression model was used for analyzation.Results: 46 patients of amelanotic melanoma and 46 of pigmented type were included in this study. The overall survival rate and progression-free survival rate of patients with pigmented melanoma were higher than in patients with amelanotic melanoma (HR = 0.533, p = .035, 95% CI = 0.296–0.957; HR = 0.530, p = .034, 95% CI = 0.294–0.953, respectively), and the risk of distant metastases in patients with amelanotic melanoma was significantly higher than that in patients with pigmented melanoma (HR = 0.474, p = .046, 95% CI = 0.228–0.987).Conclusions and significance: The prognosis and disease-free survival of amelanotic melanoma is worse than for the pigmented type group. More identifying the differences in clinical characteristics will help to further individualized treatment decisions.

Mucosal Melanomas of the Head and Neck—a Tertiary Cancer Centre Experience

Mucosal melanoma is a relatively rare tumour of the head and neck with a very poor prognosis. Managing this disease entity becomes more difficult due to high chances of disease failure locoregionally and at distant sites. This study assessed the treatment outcomes and factors affecting prognosis of head and neck mucosal melanomas. Forty-one cases of mucosal melanomas of head and neck (MMHN) treated in our institution during 10 years were retrospectively reviewed. Data regarding the clinicopathological parameters and treatment outcomes was collected. Survival was calculated using Kaplan-Meier method. The most common subsite of MMHN was upper alveolus and hard palate (39%). Thirty-one of the 41 cases underwent surgery whereas 10 cases were treated with palliative intent. At presentation, 15 of 41 cases had lymph node involvement and majority of them had primary in the oral cavity: sinonasal region had low chances of lymph node metastasis. Seventy-four percent of cases underwent adjuvant post-operative radiotherapy. For surgically treated cases, 5-year disease-specific survival (DSS) was 35.7%. Mucosal melanomas of nose and paranasal sinuses had a better overall survival than oral cavity. Distant metastasis was the most common cause of disease failure in 12 of 24 cases and had a significant association with disease-specific survival. The stage of the disease was a significant prognostic indicator. Sinonasal cavity mucosal melanomas have a better prognosis than mucosal melanomas in other subsites. Overall survival for surgically treated cases was significantly better than cases treated non-surgically. Presence of lymph node metastasis reduced the survival by 50% in MMHN.

Analysis of clinical efficacy, failure pattern and prognostic factors of comprehensive treatment for malignant mucosal melanoma of head and neck

Objective To evaluate the clinical efficacy, failure pattern and prognostic factors of the malignant mucosal melanoma of the head and neck (MMHN) in a single center. Methods The treatment pattern, clinical efficacy, failure pattern and prognostic factors of 194 M0 MMHN patients admitted to our institution from 1982 to 2017 were retrospectively analyzed. Results The 5-year overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) were 41.4%, 57.8%, 76.5% and 46.5%, respectively. The failure rate was calculated as 74.6%(141/189). Among them, 40%(56/141) had distant metastasis as the first pattern of treatment failure, 37%(52/141) had local relapse, 15%(21/141) had regional relapse, 5%(7/141) had concurrent distant metastasis and local/regional relapse and 3%(5/141) had concurrent local and regional relapse. Multivariate analysis demonstrated that surgical margins (P=0.001) and adjuvant radiotherapy (P=0.000) were the independent prognostic factors for LRFS. Conclusions Surgery combined with radiotherapy can yield relatively high LRFS in the comprehensive treatment of MMHN.Distant metastasis is the major failure pattern. Key words: Head neck neoplasmsm/radiotherapy; Melanoma/radiotherapy; Prognosis

Primary Tumor Size Predicts Distant Metastasis of Mucosal Malignant Melanoma in Head and Neck.

To investigate the possible association between primary tumor size and overall survival and/or distant metastasis-free survival of patients with mucosal malignant melanoma of the head and neck. A total of 25 patients that have had primary tumor resection were enrolled in this study. Primary tumor size was assessed as the maximum size of the primary tumor in pathological and surgical reports. Patients with a primary tumor size of ≥43 mm showed a significant association with shorter overall survival (p=0.007) and distant metastasis-free survival (p=0.005) by the log-rank test. Multivariate survival analyses of two Cox's hazards proportional models showed that, in model1, pT4a-4b (p=0.01) and primary tumor size ≥43 mm (p=0.03) were significantly associated with shorter overall survival, and primary tumor size ≥43 mm (p=0.02) was significantly associated with shorter distant metastasis-free survival. In model2, pStage IVA-IVB (p=0.02) and primary tumor size ≥43 mm (p=0.03) were significantly associated with shorter overall survival, and primary tumor size ≥43 mm (p=0.02) was significantly associated with shorter distant metastasis-free survival. Large tumor size (≥43 mm) is a predictor of shorter overall survival and distant metastasis-free survival after primary tumor resection of mucosal malignant melanoma of the head and neck.

Surgical Excision with Rotational Flap Reconstruction for Basosquamous Cell Carcinoma in Xeroderma Pigmentosa: A Case Report.

Xeroderma pigmentosa (XP) is a rare autosomal recessive disorder which is characterized by a defect in nucleotide excision repair of DNA following exposure to UV radiation. This leads to hypersensitivity to sunlight causing pigmented skin lesions, photophobia and a 1000-fold increase in risk of developing cutaneous malignancies like basal cell carcinomas, squamous cell carcinomas and melanomas of head and neck. We present an interesting case of a 28year old man with basosquamous cell carcinoma secondary to XP treated successfully with surgical excision and reconstruction with rotational flap technique.

Clinical characteristic and prognostic analyses of 117 cases of head and neck mucosal melanoma

Objective: To study the clinical characteristics of mucosal melanoma in the head and neck, including the risk factors affecting distant metastasis, recurrence and survival rate, and to provide the basis for the individualized treatment of mucosal melanoma in the head and neck. Methods: The clinical data of 117 cases of mucosal melanoma in the head and neck treated from January 2004 to June 2016 in Beijing Tongren Hospital were analyzed retrospectively, and the risk factors affecting the prognosis, distant metastasis and local recurrence were analyzed.Kaplan-Meier analysis was used for survival analysis, and Log-Rank test was used for comparison between groups. Results: The follow-up time was 5-139 months, with a median of 32 months, and the median survival time was 34 months.The 3 and 5 year cumulative survival rates were 47.0% and 25.0%, respectively.Local recurrence occurred in 27 patients (23.1%), and distant metastasis in 37 cases (31.6%). After the operation, 50 patients received radiotherapy.Multiple factor Cox regression analysis showed that distant metastasis, AJCC staging, and two operations were risk factors affecting survival (P<0.05), and immunologic/targeted therapy was a protective factor affecting survival prognosis(P=0.008). Postoperative radiotherapy and distant metastasis were important factors affecting recurrence (P<0.05). AJCC staging, pigmentation, and postoperative recurrence were risk factors for distant metastasis (P<0.05). Conclusion: The 3 and 5 year survival rates of primary mucosal melanoma in head and neck are low, and the incidence of local recurrence and distant metastasis are high. Surgery is the first choice and the integrity of the initial operation has an important impact on the prognosis of the patients. Postoperative adjuvant radiotherapy is recommended to improve the local control rate, and immunotherapy and targeted therapy should be applied in time to improve survival.

Hypofractionated Carbon-Ion Radiation Therapy for Mucosal Malignant Melanoma in Head and Neck

Mucosal malignant melanoma (MMM) in the head and neck is radio-resistant tumor, and carbon-ion radiotherapy (CIRT) is expected to overcome this refractory disease. We retrospectively evaluated the efficacy and safety of hypofractionated CIRT with or without DAV therapy (DTIC, ACNU, and VCR) for MMM patients. Between June 2011 and December 2016, 43 MMM patients were treated by CIRT. Median age was 71 years old (range: 32-91) and number of male patients was 23 (53%). T3/ T4a/ T4b diseases were 1/ 36/ 6, respectively, and all were N0M0. Nasal cavity tumors were observed in 35 patients (81%). All patients were treated using 16 fractions over 4 weeks. Thirty-nine patients received 64.0 Gy (relative biological effectiveness [RBE]) in and 4 patients received 57.6 Gy (RBE). Concurrent DAV therapy was used in 25 patients (58%) if patient met with our eligibility criteria; age ≦80, no severe liver and renal dysfunctions, and PS ≦2. Local control, progression free survival (PFS), and overall survival (OS) rates were statistically calculated by the Kaplan-Meier method and log-rank tests. A P value < 0.05 was defined as a statistical significance. Acute and late adverse events were evaluated according to the Common Terminology Criteria for Adverse Events, version 4.0. This study was reviewed and approved by our Institutional Review Board. The median follow-up time for surviving patients was 26 months. Four patients developed local recurrence and the 2-year local control rate was 88%. There was not significant difference of local control rate irrespective of the use of DAV therapy (P = 0.58). During the follow-up, 21 patients died and the 2-year OS rate was 63%. The addition of DAV therapy was not prognostic factor for OS (P = 0.24). Lymph node and distant metastases were observed in 2 and 21 patients, and the 2-year PFS were 32%. Concurrent CIRT with DAV therapy had significantly better PFS than CIRT alone (P = 0.04), and the 2-year PFS rates were 40% and 20%, respectively. Acute grade ≧2 mucositis and dermatitis were 74% and 44%, which improved immediately with conservative therapy. Late grade ≧2 mucositis and dermatitis were 23% and 3%. There were no significant differences of the non-hematologic adverse event rates between CIRT with and without DAV therapy. Concurrent CIRT with DAV therapy developed higher rates of grade ≧2 hematologic adverse events than those of CIRT alone; leukopenia was 52% vs. 11% (P = 0.03), anemia was 12% vs. 0% (P = 0.08), thrombocytopenia was 40% vs. 0% (P = 0.01), respectively. Hypofractionated CIRT contributed to the excellent local control with tolerable toxicities for MMM in the head and neck. Concurrent CIRT with DAV therapy showed the better PFS than CIRT alone, and long-term observation will be necessary to confirm its significance. The addition of DAV therapy was associated with the hematologic adverse events, but not with the radiation-related mucositis and dermatitis.

IRF4 rs12203592 functional variant and melanoma survival.

Inherited genetic factors may modulate clinical outcome in melanoma. Some low-to-medium risk genes in melanoma susceptibility play a role in melanoma outcome. Our aim was to assess the role of the functional IRF4 SNP rs12203592 in melanoma prognosis in two independent sets (Barcelona, N = 493 and Essen, N = 438). Genotype association analyses showed that the IRF4 rs12203592 T allele increased the risk of dying from melanoma in both sets (Barcelona: odds ratio [OR]=6.53, 95% CI 1.38-30.87, Adj p = 0.032; Essen: OR = 1.68, 95% CI 1.04-2.72, Adj p = 0.035). Survival analyses only showed significance for the Barcelona set (hazard ratio = 4.58, 95% CI 1.11-18.92, Adj p = 0.036). This SNP was also associated with tumour localization, increasing the risk of developing melanoma in head or neck (OR = 1.79, 95% CI 1.07-2.98, Adj p = 0.032) and protecting from developing melanoma in the trunk (OR = 0.59, 95% CI 0.41-0.85, Adj p = 0.004). These findings suggest for the first time that IRF4 rs12203592 plays a role in the modulation of melanoma outcome and confirms its contribution to the localization of the primary tumour.

Czerniaki złośliwe głowy i szyi w materiale Katedry i Kliniki Laryngologii SUM: analiza histo-kliniczna

Summary Introduction In 2008 in Poland, there were over 2,200 cases of malignant melanomas. This tumor is characterized by considerable malice. Malignant melanoma of the head and neck region is a vast concept. Therefore it includes cutaneous, ocular, mucous membranes and metastatic melanomas. Methods A retrospective analysis of patients admitted to ENT Department of Silesian Medical University in Katowice with diagnosis of head and neck malignant melanoma. Results Between 1983 and 2009 10 cases of melanoma of head and neck were registered in our Department. Six patients presented ocular melanoma. They manifested disturbed vision and exophtalmus. All of them underwent orbital exenteration of affected eye. One case of melanoma arising from palatine tonsil was registered. Main symptom was tumor of the neck. One patient suffered from melanoma of nasal cavity, which manifested as reccurent epistaxis. Metastatic melanoma was found in 2 cases. One of them involved parotid gland tumor, another- supraclavicular nodes. Every patient underwent excision of tumor. Patient with supraclavicular nodes involvement – Crile operation. Discussion The most important diagnostic procedure in every form of melanoma is histopathological examination which reaveles atypical melanocytes. Radical excision of primary lesion has a great importance in long term prognosis. Radio-, chemo- and immunotherapy remain auxiliary treatment, often in advanced stage of disease.

Tailored excision of in-transit metastatic melanoma based on indocyanine green fluorescence lymphography

In-transit metastases of melanoma almost certainly results from lymphatic dissemination of melanoma cells to tissues between the primary melanoma site and the draining regional lymph nodes. Most in-transit metastases occur after lymphatic obstruction, due either to tumor involvement or to surgical removal. The treatment of in-transit metastatic melanoma has not been standardized, and should be tailored accordingly. We report a case of in-transit metastatic melanoma in head and neck after regional lymph node dissection. In-transit metastases in the cheek were excised with tailored surgical margins based on the evaluation of lymph flow using indocyanine green (ICG) fluorescence lymphography. ICG fluorescence lymphography has been reported recently in non-invasive sentinel lymph node mapping, and lymphaticovenous anastomosis. Using this system, not only sentinel lymph nodes and lymph vessels but also dermal lymphatic back flow caused by previous surgery is detectable as a white spot through fluorescence high-sensitivity near-infrared video camera system. This enables our detection of abnormal lymphatic flow, which indicates possible areas of melanoma cell spreading through the lymphatic system. Although a preliminary case report, we propose tailored excision of in-transit metastatic melanoma based on ICG fluorescence lymphography.

Czerniaki złośliwe regionu głowy i szyi w materiale Kliniki Chirurgii Onkologicznej i Rekonstrukcyjnej Centrum Onkologii IMSC w Gliwicach

About 25% of melanomas are localized in head and neck skin, and this particular localization is most difficult to treat, and the prognosis is less favorable. The depth of melanoma infiltration (Clark and Breslau grade) into the skin is the main factor of local advancement of the disease. Surgical treatment is an essential therapeutic modality in patients with melanoma. The aim of this study was to evaluate results of our surgical treatment of melanomas in head and neck localisation, treated from 1997 to 2007 in Department of Oncological and Reconstructive Surgery in Center of Oncology IMSC in Gliwice. We analysed group of 47 patients (aged 26 to 75 years, mean 49), treated by surgical excision of malignant melanoma in the head and neck region. Most of the patiens required to use free flaps or skin graft technique to close posexcisional defect, on basis of clinical considerations. The 5-year total survival for all patients was 62% and were dependent on depht of melanoma infiltration and regional lymph node metastasis. The significant prognostic factors were: localization of primary focus, local progression of disease, free microscopical excision margins sex and age. Prognosis in the patients with melanoma of the head and neck is unreliable and dependent on local advancement of disease and localization of primary focus. Surgical treatment is an essential therapeutic modality in patients with melanoma. Adiuvant radiotherapy after surgical treatment of melanoma of the head and neck is intended for the patiens with high risk of local or regional recurence of disease.

Mucosal malignant melanomas in head and neck surgery: a retrospective study of six patients and review of the literature

Of all malignant processes of the oral mucosa, 0.5% are malignant melanomas. Because of late diagnosis, pattern of growth, close proximity to the bone (particularly in palatinal localizations), and the correlated infiltration, malignant melanomas have a bad prognosis. In this retrospective study, six cases of patients with oral mucosal malignant melanoma are evaluated, and a critical review of the literature is presented. The female to male proportion was 1:1 with an average age of 60.2 years; all patients were treated between January 1999 and July 2007. A neck dissection was performed on two patients because of clinically positive lymph nodes; one patient received interleukin 2 therapy, and three patients received postoperative radiotherapy. Two male patients died. We recommend biopsy on every growing lesion, pigmented or nonpigmented, for the required diagnosis and, in cases of malignant melanoma, wide excision as a second step. Neck dissections should be performed in patients with clinically positive lymph nodes. Concerning interleukin 2 therapy, further studies should be performed in order to evaluate a routine application.

Solar Elastosis in Cutaneous Melanoma

By studying more than 1,200 patients with cutaneous melanoma and long-term follow-up, I examined the relationship between solar elastosis and age at diagnosis of melanoma, key features of melanoma, and the outcome of overall survival in melanoma. I found that melanomas with elastosis were diagnosed significantly later than those without elastosis (P approximately 0; log-rank test). This result may be because elastosis is positively related to age. However, I also found that melanomas of head and neck areas, which tend to have more elastosis, were diagnosed at later ages than melanomas of other body sites (P = 1.2 x 10-5; log-rank test). Thus, a second explanation for the results favors a protective effect of elastosis on the development of cutaneous melanoma, possibly related to increased levels of vitamin D. I also found that once melanoma develops, cases with elastosis demonstrated no differences in thickness, mitotic rate, ulceration, or overall survival time from cases without elastosis.

Przypadek czerniaka złośliwego trąbki słuchowej

Melanomas of the mucous membranes of airway tract constitute around 1% of the total melanomas of head and neck. The most common site of the tumor are the nasal and paranasal sinuses but melanomas of the oral cavity are described too. The location of malignant melanoma in the eustachian tube is very rare. We found five cases of this disease in the literature. In our article we present a 53-year-old woman with progressive left aural fullness and hearing impairment for two months. Clinical examination found left middle ear effusion. The nasopharyngoscopy revealed a bluish red, friable and granulomatous tumor occupying the whole pharyngeal orifice of the left auditory tube. The biopsy speciment was taken which established the diagnosis. Because of localization and spread of the melanoma we had a low opinion of surgical treatment and radiotherapy was recommended. The patient was under constant laryngologic and oncological observation. We did not notice the local recurrence of melanoma. She died two years after making the diagnosis because of the neoplasm dissemination.

Pancreatic head melanoma producing obstructive jaundice: Magnetic resonance characteristics aiding differentiation from adenocarcinoma

A case is reported of malignant melanoma presenting as a mass in the head of the pancreas producing obstructive jaundice. On MR imaging the mass displayed signal characteristics not typical of adenocarcinoma but instead exhibited a low signal on T2-weighted images and early phase dynamic enhancement, the combination of which should suggest the possibility of melanoma.

Treatment of malignant melanoma of the lower eyelid using anterolateral thigh flap

Malignant melanoma is a poor prognostic disease with the potential for high mortality despite early diagnosis and currently available treatment. Surgical judgment pertaining to the extent of primary resection and regional node dissections must be tempered by cosmetic considerations and by the anatomically diffuse pathways for lymphatic spread in certain lesions. We reported a case of malignant melanoma of the left lower eyelid, and presented the surgical excision and reconstruction using anterolateral thigh flap for skin defect. It is evident that comprehensive treatment using radical surgery and adjuvant chemotherapy is necessary for cutaneous malignant melanoma of head and neck areas.