Mucosal Melanoma Of The Head And Neck Research Articles

Mucosal melanoma of the head and neck: a retrospective analysis of 34 cases in Japan

Purpose Mucosal melanoma of the head and neck (MMHN) is a rare condition. This study aimed to investigate oncological outcomes of surgical intervention in patients with MMHN. Materials and methods The study included 34 patients with MMHN who underwent surgical resection as initial treatment at 10 institutions in Japan between July 2005 and June 2015. Results: The 5-year overall survival (OS), local control rate (LCR), disease-free survival (DFS), and disease-specific survival (DSS) rates were 48.7%, 53.4%, 32.4%, and 55.1%, respectively. Based on multivariate analysis, no independent prognostic factors for the 5-year OS and DSS were found. Based on univariate analysis, the 5-year LCR was worse in patients with lesions in the nasal cavity and paranasal sinuses than in the oral cavity and pharynx. However, no differences in oncological outcomes were identified in relation to primary sites, and postoperative radiotherapy (PORT) and adjuvant systemic therapy did not contribute to improvements in the 5-year OS. Conclusions No independent prognostic factors for the 5-year OS or DSS were identified. Regional or distant recurrences are often identified, regardless of local control with surgical resection. Difficult control of MMHN with conventional therapeutic strategies, such as surgical intervention, PORT, and systemic therapy, has been suggested.

Epidemiology, staging and management of mucosal melanoma of the head and neck: a narrative review.

Mucosal melanoma of the head and neck (MMHN) are rare, aggressive neoplasms of melanocyte origin that remain incompletely understood and have a poor prognosis, with high rates of locoregional recurrence and distant metastasis. Several recent studies having expanded understanding of MMHN, we undertook a review of the latest evidence pertaining to its epidemiology, staging, and management. A literature search was conducted for peer-reviewed articles reporting and discussing the epidemiology, staging, and management of MMHN. PubMed, Medline, Embase and the Cochrane Library were searched to identify relevant publications. MMHN remains an uncommon disease. The current TNM staging system for MMHN provides inadequate risk stratification, and consideration of an alternative staging model such as one based on a nomogram may be justifiable. Tumour resection with clear histological margins remains the cornerstone of optimal treatment. Adjuvant radiotherapy may improve locoregional control but does not appear to affect survival. Immune checkpoint inhibitors and c-KIT inhibitors demonstrate promising efficacy in patients with advanced or unresectable mucosal melanomas, and warrant further research exploring the utility of combination therapies. Their roles as adjuvant therapies have not been determined. The efficacy of neoadjuvant systemic therapy is also not yet clear, although early results suggest that it may improve outcomes. New insights into the epidemiology, staging and management of MMHN have transformed the standard of care for this rare malignancy. Nonetheless, the results of ongoing clinical trials and future prospective studies are required to better understand this aggressive disease and optimise its management.

Treatment outcomes of mucosal melanoma of the head and neck: Analysis of 190 cases from a single institution.

To analyze the treatment outcomes and prognostic factors of mucosal melanoma of the head and neck (MMHN) from a single institution. From December 1989 to November 2018, 190 patients diagnosed with MMHN were included. Survival analysis was performed using the Kaplan-Meier method for univariate analysis with a log-rank test for significance and Cox regression for multivariate analysis. With a median follow-up time of 43.5 months, 126 (68.5%) patients died. The median DSS was 35 months. The 3- and 5-year disease-specific survival (DSS) rates were 48.1% and 33.7%, respectively. The median overall survival (OS) was 34 months. The 3- and 5-year OS rates were 47.0% and 32.9%, respectively. In univariate analysis, the T3 stage, received surgery, R0 resection, and combined therapy (surgery+biotherapy/biochemotherapy) were significantly associated with better survival. Multivariable Cox regression analysis revealed that the T4 stage (HR = 1.692; 95% CI, 1.175-2.438; p = .005) and the N1 stage (HR = 1.600; 95% CI, 1.023-2.504; p = .039) were strong prognostic factors for poor survival, and that combined therapy (surgery+biotherapy/biochemotherapy) was a strong prognostic factor for better survival outcome (HR = 0.563; 95% CI, 0.354-0.896; p = .015). The prognosis of MMHN remains poor. Systemic treatment is warranted to reduce MMHN progression. Surgery combined with biotherapy may improve survival.

A nomogram for predicting survival of head and neck mucosal melanoma

ObjectivesWe aimed to understand the clinical characteristics and better predict the prognosis of patients with mucosal melanoma of the head and neck (MMHN) using a nomogram.MethodsThree hundred patients with nometastatic MMHN were included. Multivariable Cox regression was performed to analyze independent prognostic factors for overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS), and these factors were used to develop a nomogram. Concordance indexes (C-indexes), calibration plots, and receiver operating characteristic (ROC) analysis were performed to test the predictive performance of the nomogram in both the primary (n = 300) and validation cohorts (n = 182).ResultsThe primary tumor site, T stage and N stage were independent risk factors for survival and were included in the nomogram to predict the 3- and 5-year OS, DFS, DMFS, and LRRFS in the primary cohort. The C-indexes (both > 0.700), well-fit calibration plots, and area under the ROC curve (both > 0.700) indicated the high diagnostic accuracy of the nomogram, in both the primary and validation cohorts. The patients were divided into three groups (high-risk, intermediate-risk, and low-risk groups) according to their nomogram scores. The survival curves of OS, DFS, DMFS, and LRRFS were well separated by the risk groups in both cohorts (all P < 0.001).ConclusionsThe nomogram can stratify MMHN patients into clinically meaningful taxonomies to provide individualized treatment.

Importance of Margins, Radiotherapy, and Systemic Therapy in Mucosal Melanoma of the Head and Neck.

The ideal strategy in the treatment of mucosal melanoma of the head and neck (MMHN) remains unclear. Our objective was to evaluate the importance of surgical margins, radiotherapy, and systemic therapy in MMHN. Retrospective Single Institutional Review. Retrospective review of patients with MMHN treated at a tertiary care oncology center between 1999 and 2016. Seventy-six patients were included, 60 of whom were treated with curative intent. Negative or close margins compared with positive margins were associated with higher 3-year overall survival (OS) (62% vs. 29% vs. 13% P= .012), disease-free survival (33% vs. 29% vs. 4% P= .003), and distant control (48% vs. 29% vs. 22% P= .039). Cases with pre-/postoperative radiotherapy had a marginally higher locoregional control versus without (69% vs. 59%, P= .117). Immunotherapy for recurrent and/or metastatic disease was associated with an increase in 3-year OS (15% vs. 3% P= .01). Achieving negative surgical margins is relevant in disease control. Despite small sample size, our data suggest that radiotherapy may enhance surgical outcomes. Immunotherapy has therapeutic benefit. 3 Laryngoscope, 131:2269-2276, 2021.

A Nomogram to Predict Locoregional Recurrence after Surgery and Postoperative Adjuvant Radiation Therapy for Primary Mucosal Melanoma of the Head and Neck

To evaluate postoperative radiotherapy (PORT) on prognosis for patients with mucosal melanoma of the head and neck (MMHN) and create a specific nomogram to predict the probability of locoregional recurrence (LRR) of MMHN after surgery and PORT. We retrospectively reviewed 111 patients with non-metastatic MMHN who underwent definitive surgical treatment with PORT between January 2008 and December 2018. Clinical characteristics and blood test parameters were analyzed for relationships with treatment outcomes, and a nomogram was created to estimate the risk of LRR using R software. The median follow-up was 44.2 months (range, 5.9–111 months), and we identified 17 local recurrence (15.3%), 1 regional lymph node metastasis (0.9%), and 33 distant metastases (29.7%). Relative to later recurrence, early locoregional recurrence (<2 years after surgery and PORT) was associated with poorer overall survival (OS) (P = 0.001). The multivariate analysis revealed that independent risk factors for better locoregional recurrence-free survival (LRRFS) included age > 56 years, bilirubin (BIL) > 8.5 μmol/L, Mg2+ > 0.8 mmol/L, mean corpuscular hemoglobin (MCH) < 32.3 pg and mean platelet volume (MPV) <10.0 fL. These five factors were used for the nomogram which had a C-index of 0.884 for predicting LRR, and internal validation revealed a good discriminative ability. Early locoregional recurrence (<2 years) was associated with poor OS of MMHN after surgery and PORT. Our nomogram may be useful for predicting LRR of MMHN, and internal validation confirmed good discriminative ability.

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

Long-term treatment outcomes and prognosis of mucosal melanoma of the head and neck: 161 cases from a single institution

ObjectivesThis study aimed to evaluate the clinical features, treatment outcomes and prognostic factors of mucosal melanoma of the head and neck (MMHN) in patients who were treated at our institution. Materials and methodsBetween Jan. 1981 and Oct. 2015, 161 patients with non-metastatic MMHN were treated at our institution. The patients’ clinical characteristics, treatment modalities, outcomes, prognostic factors, and failure patterns were retrospectively analysed. ResultsWith a median follow-up time of 74months, the 5-year overall survival rate (OS), local control rate (LC), distant metastasis-free survival (DMFS) were 44.4%, 59.4%, and 49.3%, respectively. Regarding the different treatment modalities, the 5-year OS was 50.0% in the surgery group and 43.1% in the surgery combined with radiotherapy group, while, the 5-year LC rate was 42.5% in the surgery group and 75.3% in the surgery combined with radiotherapy (p<0.001). According to the AJCC 7th edition staging system for MMHN, the 5-year OS for patients with stage III, stage IVA, and stage IVB MMHN were 65.2%, 33.1% and 14.3%, respectively (p<0.001). In the multivariate analysis, the T stage, neck lymph node involvement, and surgical margins were independent prognostic factors for OS; surgical margins and adjuvant radiotherapy were independent prognostic factors for LC. ConclusionThe addition of radiotherapy improves the local control rate of MMHN. T stage, neck lymph node status, and surgical margins are independent prognostic factors for the OS in patients with MMHN. The AJCC 7th edition staging system for MMHN appears to effectively stage this disease.

Multicenter Study of Carbon-Ion Radiation Therapy for Mucosal Melanoma of the Head and Neck: Subanalysis of the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS) Study (1402 HN)

Toevaluate the efficacy and safety of carbon-ion radiation therapy (RT) for mucosal melanoma of the head and neck (MMHN) in the Japan Carbon-Ion Radiation Oncology Study Group study. Patients with MMHN with N0-1M0 status who were treated with carbon-ion RT at 4 institutions in Japan between November 2003 and December 2014 were analyzed retrospectively. Two hundred sixty patients (male, 111; female, 149; median age, 68years) with histologically proven MMHN were enrolled. Primary sites included the nasal cavity in 178 patients, paranasal sinuses in 43, oral cavity in 27, and pharynx in 12. Eighty-six patients had T3 tumors, 147 had T4a tumors, and 27 had T4b tumors. Two hundred fifty-one patients were diagnosed with N0 disease, and 9 with N1 disease. The median total dose and number of fractions were 57.6Gy RBE (relative biological effectiveness) and 16, respectively. Chemotherapy including dimethyl traizeno imidazole carboxamide was used concurrently in 129 patients. The median follow-up duration was 22months (range, 1-132months). The 2-year overall survival and local control rates were 69.4% and 83.9%, respectively. Multivariate analysis showed that gross tumor volume and concurrent chemotherapy were significant prognostic factors for overall survival. Grade 3 and grade 4 late morbidities were observed in 27 and 7 patients (5 developed ipsilateral blindness, 1 mucosal ulcer, and 1second malignant disease in the irradiated volume), respectively. No patients developed grade 5 late morbidities. Carbon-ion RT is a promising treatment option for MMHN.

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

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.

Primary mucosal melanoma of the head and neck in Denmark, 1982–2012: Demographic and clinical aspects. A retrospective DAHANCA study

Background The study was performed to determine the epidemiological, clinical, and histopathological characteristics and prognosis of primary mucosal melanoma of the head and neck (MMHN) in Denmark.Material and methods This was a national retrospective multicenter study of patients diagnosed with MMHN between 1982 and 2012 in Denmark. Data were retrieved from national databases and patient records. Incidence trends were examined for the entire period. We prepared survival curves and performed univariate and multivariate analysis for the period 1992–2012 to identify possible prognostic factors. Results No significant trends in incidence were found in the study period. The three-year overall and disease-free survival rates for MMHN were 46.5% and 35.5%, respectively. Negative margins was an independent predictor of disease-free survival, and age below 65, absence of distant metastases, and low overall TNM stage were predictors of overall survival. Radiotherapy did not improve survival significantly. Recurrence rates were high, even for patients with negative margins. Conclusions MMHN remains a rare disease with a poor prognosis, particularly for patients aged over 65, those with distant metastasis, and those with advanced TNM stage. Importantly, the rate of recurrence is lowest in patients with negative margins.

Survival Outcomes of Mucosal Melanoma in the Head and Neck: Case Series and Review of Current Treatment Guidelines

Malignant mucosal melanoma of the head and neck (MMHN) is an aggressive and rare neoplasm with poor long-term outcomes. The aim of this study is to evaluate the outcomes of patients treated by a single-institution head and neck multidisciplinary team. In this retrospective case series, all MMHN cases treated at the Royal Melbourne Hospital from 1990-2015 were retrospectively reviewed. Patient demographic characteristics (eg, age), treatment offered, pathology, and outcomes were collected, tabulated, and correlated with outcomes. Survival outcomes were calculated by the Kaplan-Meier method. Comparison was made between oral and sinonasal melanomas. A total of 16 cases were identified. Two were excluded because of inaccessible data. Of the 14 remaining cases, 8 were sinonasal melanomas and 6 were oral cavity melanomas. Sinonasal tumor patients presented with epistaxis or visual impairment. Oral melanoma patients presented with pigmented lesions or ulceration. Follow-up ranged from 4months to 11years. In 2 patients, locoregional recurrences developed that were successfully re-excised. Six patients died of distant metastases despite clear surgical margins. Two patients with sinonasal melanomas died of extensive local disease with intracranial invasion. One patient died 4years after diagnosis without disease. There were no failures in the neck. The 2- and 5-year overall survival rates were 63.3% and 31.7%, respectively, by the Kaplan-Meier method. The difference in survival between oral and sinonasal melanomas was not statistically significant. Despite clear surgical margins, MMHN has a poor prognosis and most deaths are due to distant metastases. Systemic therapies such as those used in cutaneous melanoma treatment might be used in the future for MMHN.

Rising Incidence of Mucosal Melanoma of the Head and Neck in the United States

Background. While it is established that the incidence of cutaneous melanoma has risen over time in the United States, the incidence trend for mucosal melanoma of the head and neck (MMHN) is unknown. Methods. We used the Surveillance, Epidemiology, and End Results (SEER) database to determine incidence trends for MMHN from 1987 to 2009 in the United States. We determined annual percent change (APC) by weighted least squares and joinpoint regression analysis. Results. MMHN incidence increased from 1987 to 2009 (APC 2.4%; P < 0.01). Nasal cavity lesions increased in incidence (APC 2.7%; P < 0.01) over this duration, while the incidence of non-nasal cavity lesions remained stable. The highest rate of increase was in white females ages 55 to 84 (APC 5.1%; P = 0.01). Conclusions. The incidence of MMHN in the United States has been rising since 1987. This trend is driven primarily by increased incidence of nasal cavity melanomas.

Predictors of Survival in Mucosal Melanoma of the Head and Neck

The head and neck is the most common site of mucosal melanoma, a cancer with poor prognosis. In contrast to cutaneous melanoma, mucosal melanoma of the head and neck (MMHN) is uncommon, with limited data regarding outcomes and prognostic factors drawn from small, single-institution case series. In order to identify factors predictive of survival, we analyzed MMHN outcomes in a large US cohort. MMHN cases (n = 815) diagnosed in the USA between 1973 and 2007 were analyzed in the Surveillance, Epidemiology, and End Results registry, and cause of death was individually determined in 778 (95.5%) cases. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to analyze prognostic variables. Disease-specific survival status was determined in 778 (95.5%) cases. The 5- and 10-year rates of overall survival (OS) were 25.2 and 12.2%; disease-specific survival (DSS), 32.4 and 19.3%. On multivariable analysis, anatomic primary site was an independent predictor of OS and DSS, with tumors in the nasal cavity and oral cavity associated with survival superior to tumors in the nasopharynx and paranasal sinuses. Age > 70 years, tumor size, nodal status, and distant metastasis status were additional independent predictors of poorer survival. In this large cohort of patients with MMHN, we have identified several novel factors robustly predictive of overall and melanoma-specific survival.

Mucosal melanoma of the head and neck

Mucosal melanoma of the head and neck (MMHN) is a rare malignant tumor associated with a poor prognosis. A retrospective study of case records of patients treated at our department between 1992 and 2010 was carried out. Thirteen patients were enrolled. The median age of the patients (3 males and 10 females) was 61 years (range 39-78). The median follow-up period was 48 months (range 10-115). Two common primary sites were the nasal cavity (8 cases) and sinonasal complex (5 cases). Ten patients (77%) received curative surgery. Chemotherapy was administered to 10 patients. In addition, lymphokine-activated killer (LAK) cell therapy was administered to 7 patients as adjunctive immunotherapy after the initial treatment course. The overall 5-year, cause-specific survival rate was 56%. Patients who received adjunctive LAK cell therapy had a survival rate of 67% at 5 years, while patients who did not receive adjunctive LAK cell treatment had a survival rate of 33%. MMHN is associated with a poor survival rate. The most common cause of death is distant metastasis. Surgery, radiotherapy and chemotherapy are common strategies for MMHN, but the control of metastasis is difficult. The use of immunotherapy remains uncommon for MMHN. However, from the viewpoint of a systemic disease, due to its high rate of metastases, immunotherapy using LAK cell treatment may contribute to the improvement of prognosis in patients with MMHN.

Mucosal Melanoma of the Head and Neck: Tata Memorial Hospital Experience

AbstractBackgroundPrimary mucosal melanoma of the head and neck (MMHN) is a rare, aggressive tumor of neural-crest origin. Despite universal progress in cancer care, the prognosis of MMHN continues to remain dismal.AimsTo analyze and report the outcomes of primary head and neck mucosal melanomas treated at Tata Memorial Hospital.MethodsRetrospective chart review of all patients with a diagnosis of nonocular MMHN presenting to the institute between 1995 to 2003. Locoregional control and disease-free survival were used as outcome measures.Results42 patients presenting within the study period with nonocular MMHN (oral-55%, sinonasal-40%, and pharyngeal-5%) at a median age of 53 years constituted the demographic cohort. 11 (26%) patients not amenable to any active anticancer treatment were treated with best supportive care alone and excluded from outcome analysis. 26 patients underwent surgery with complete resection of tumor. Seven (27%) also received adjuvant radiotherapy due to the adverse histopathologic features. Two patients were treated with radical radiotherapy due to unresectability, two patients received palliative chemotherapy, while one patient was treated with definitive chemoradiotherapy. With a mean follow-up of 11 months (range 1-58 months), the 3-year locoregional control and disease-free survival was 41% and 12% respectively. Age, sex, site of primary, tumor stage, surgical resection, margin status, depth of infiltration, and adjuvant radiotherapy did not affect outcome significantly.ConclusionPrimary mucosal melanoma of the head and neck is a rare, but, aggressive tumor with a dismal prognosis. Surgical resection with clear margins offers the best chance of cure for early localized disease. The high incidence of locoregional as well as distant failures after surgical resection supports the use of adjuvant therapy. Deeper insights into the pathobiology of disease can help develop more specific and effective treatment strategies to improve long-term outcomes.

Malignant Mucosal Melanoma of the Head and Neck Diagnosed in an Iranian Population over an 11-Year Period

Problem statement: Mucosal Melanoma of the Head and Neck (MMHN) is a rare lethal disease. This malignancy accounts for half of all m ucosal melanomas, occurring mainly in the nasal cavity, oral cavity and pharynx. They appear with e qual gender distribution and with a peak incidence in the age range 60-80 years. The aim of this study was to investigate incidence, sex, age and site distribution of MMHN in the Kerman province during the time period from March 1991-2002. Approach: Documents and records of 52 patients with MMHN diagnosed from March 1991-2002 were reviewed. The patients were analyzed according to gender, age and location of the tumor. Data included in the present retrospective study were an alyzed by SPSS13.5 statistical software, t-test and chi-square. Results: During this time period, 52 cases (25 men and 27 w omen) of MMHN were diagnosed. The age range was 7-84 years. The nasal cavity (55.8%) was the most affected site. The palate and upper gingiva was the most common site i n the oral cavity (8 patients, 88.8%). Survivals 5 years in MMHN patients were 27% and patients with mucosal melanoma of oral cavity have an 11%, 5 year survival rate. Conclusion: Comparison between the findings of this study with the results obtained by other investigators showed a relative c onsistency.