Management Of Mucosal Melanoma Research Articles

Local Therapy in the Management of Mucosal Melanoma: An NCDB Analysis

Local Therapy in the Management of Mucosal Melanoma: An NCDB Analysis

Malignant mucosal melanoma of paranasal sinuses: A case report.

IntroductionMucosal melanoma of paranasal sinuses is a rare disease with a challenging treatment and a poor prognosis. In this paper, we reported the successful multimodality treatment of malignant mucosal melanoma of frontal sinus.Case presentationA 65-year-old female presented with a frequent nosebleed for one month before admission. Computed tomography and magnetic resonance imaging showed a mass in the right frontal and ethmoidal sinuses with adjacent bone erosion and right orbit invasion. Biopsy revealed malignant melanoma. No metastasis was found. The definitive diagnosis was malignant mucosal melanoma of paranasal sinuses AJCC stage IVb (T4bN0M0). We used right frontobasal craniotomy to resect tumor for local control of the disease. Immunohistochemical staining was Melan A(+), S100(+), and HMB45(+). A week postoperative, she received adjuvant radiotherapy and immunotherapy (pembrolizumab). For three months postoperative, the patient had no recurrence and metastasis, no headache and no new neurological deficits. She returned to her daily activities.Clinical discussionMucosal melanoma of paranasal sinuses is usually aggressive and diagnosed at an advanced stage. Management options are surgery, radiation therapy, chemotherapy, and immunotherapy. These options were performed on a case-by-case basis and depend on the extent and location of the tumor. Despite that, the prognosis remains very poor, with a high rate of local recurrences and distant metastases. Therefore, post-treatment lifetime and frequent follow-ups are highly recommended.ConclusionThe critical issues in management of mucosal melanoma are early diagnosis, multimodality treatment, and frequent follow-ups.

Primary Mucosal Melanoma: Uncommonly Described Entity

Because of rarity and clinical challenges arising from different anatomic location, our understanding of optimal management of mucosal melanoma remains limited. The most common sites for primary mucosal melanoma are head and neck followed by anorectal, and vulvovaginal regions. Data are limited but improved understanding has led to change in management from more radical excision to conservative surgery with negative margins. We try to summarize available evidences for management this uncommonly described entity.

Malignant mucosal melanoma of the head and neck

Fortunately, primary malignant mucosal melanoma of the head and neck is a rare entity. A paucity of data elucidating the predictive factors as well as the unpredictable and aggressive biologic behavior of mucosal melanoma compound the vexing clinical situation. This review summarizes what the literature reveals about the epidemiology, patient survival, patterns of local recurrence, and local and distant metastasis of the disease. Over 1000 patients with this disease have been reported. Survivals at 5 and 10 years is 17% and 5%, respectively. Approximately 19% of patients present with lymph node metastasis and another 16% develop lymph node metastases after treatment, whereas 10% present with distant metastasis. Local metastasis does not affect survival; this is in sharp contrast with skin melanoma. Over 50% of patients experience local treatment failure, and salvage treatment is effective in only 25% of these cases. Local failure is the harbinger of distant metastases. Patients with nasal mucosal melanoma have a 31% 5-year survival rate, whereas sinus melanoma patients fare poorly, with a 0% rate of 5-year survival. The authors conducted a retrospective review of 14 patients with characteristics similar to those in the literature in terms of outcome. The 5-year survival rate for these patients was 14%. Whole-body positron emission tomography was performed on 3 patients to detect metastatic disease. The patterns of local recurrence, distant metastasis, and survival for these patients were compared with the same data for patients described in the literature. Surgery appears to have the greatest efficacy in the management of mucosal melanoma, although radiation therapy may play an increasingly important role in the future.