Clin Exp Otorhinolaryngol.  2017 Mar;10(1):97-103. 10.21053/ceo.2016.00094.

The Prognostic Role of the Surgical Approach and Adjuvant Therapy in Operable Mucosal Melanoma of the Head and Neck

• Lee G
• Baek CH
• Choi NY
• Chung MK

• KMID: 2376415
• DOI: http://doi.org/10.21053/ceo.2016.00094

Abstract

OBJECTIVES
The aim of this study was to investigate the prognostic impact of the surgical approach and adjuvant treatment in operable malignant melanoma of head and neck (MMHN).
METHODS
Retrospective reviews of 31 patients who underwent surgery-based treatment with curative intent, either by the endoscopic or external approach, for MMHN were performed to analyze recurrence patterns, salvage modalities, and oncological outcomes (disease-specific survival and disease-free survival).
RESULTS
Overall recurrence rate was 61% (19/31). In stage III patients (n=24), 50% (12/24) developed recurrences with a median recurrence-free period of 6.0 months, and 30% (4/12) of them was successfully salvaged by reoperation with adjuvant radiotherapy. On the contrary, all stage IVA patients (n=7) developed recurrences with a median recurrence-free period of 4.4 months. Distant metastasis was the most common pattern of failure and no patients were salvaged. Among variables, age and T classification, not the surgical approach, were significant prognosticators for disease-free survival and disease-specific survival. Adjuvant radiotherapy was associated with a lower rate of local failure, compared to surgery alone (hazard ratio, 0.02; 95% confidence interval, 0.06 to 0.75; P=0.02). However, adjuvant systemic therapy was not effective in reducing the risk of failures for any pattern.
CONCLUSION
Our data suggested that meticulous surgical resection, either by the endoscopic or external approach, with adjuvant radiotherapy increases the local control rate in MMHN.

Keyword

Mucosal Melanoma; Head and Neck; General Surgery; Prognosis; Radiotherapy

MeSH Terms

Classification
Disease-Free Survival
Head*
Humans
Melanoma*
Neck*
Neoplasm Metastasis
Prognosis
Radiotherapy
Radiotherapy, Adjuvant
Recurrence
Reoperation
Retrospective Studies

Reference

1. Christopherson K, Malyapa RS, Werning JW, Morris CG, Kirwan J, Mendenhall WM. Radiation therapy for mucosal melanoma of the head and neck. Am J Clin Oncol. 2015; Feb. 38(1):87–9.

2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013; Jan. 63(1):11–30.

3. Lund VJ, Chisholm EJ, Howard DJ, Wei WI. Sinonasal malignant melanoma: an analysis of 115 cases assessing outcomes of surgery, postoperative radiotherapy and endoscopic resection. Rhinology. 2012; Jun. 50(2):203–10.

4. Won TB, Choi KY, Rhee CS, Jin HR, Yi JS, Dhong HJ, et al. Treatment outcomes of sinonasal malignant melanoma: a Korean multicenter study. Int Forum Allergy Rhinol. 2015; Oct. 5(10):950–9.

5. Gru AA, Becker N, Dehner LP, Pfeifer JD. Mucosal melanoma: correlation of clinicopathologic, prognostic, and molecular features. Melanoma Res. 2014; Aug. 24(4):360–70.

6. Chan RC, Chan JY, Wei WI. Mucosal melanoma of the head and neck: 32-year experience in a tertiary referral hospital. Laryngoscope. 2012; Dec. 122(12):2749–53.

7. Troussier I, Baglin AC, Marcy PY, Even C, Moya-Plana A, Krengli M, et al. Mucosal melanomas of the head and neck: state of the art and current controversies. Bull Cancer. 2015; Jun. 102(6):559–67.

8. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York (NY): Springer;2009.

9. Gal TJ, Silver N, Huang B. Demographics and treatment trends in sinonasal mucosal melanoma. Laryngoscope. 2011; Sep. 121(9):2026–33.

10. Benlyazid A, Thariat J, Temam S, Malard O, Florescu C, Choussy O, et al. Postoperative radiotherapy in head and neck mucosal melanoma: a GETTEC study. Arch Otolaryngol Head Neck Surg. 2010; Dec. 136(12):1219–25.

11. Wushou A, Hou J, Zhao YJ, Miao XC. Postoperative adjuvant radiotherapy improves loco-regional recurrence of head and neck mucosal melanoma. J Craniomaxillofac Surg. 2015; May. 43(4):553–8.

12. Nicolai P, Battaglia P, Bignami M, Bolzoni Villaret A, Delu G, Khrais T, et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol. 2008; May-Jun. 22(3):308–16.

13. Penel N, Mallet Y, Mirabel X, Van JT, Lefebvre JL. Primary mucosal melanoma of head and neck: prognostic value of clear margins. Laryngoscope. 2006; Jun. 116(6):993–5.

14. Stern SJ, Guillamondegui OM. Mucosal melanoma of the head and neck. Head Neck. 1991; Jan-Feb. 13(1):22–7.

15. Guzzo M, Grandi C, Licitra L, Podrecca S, Cascinelli N, Molinari R. Mucosal malignant melanoma of head and neck: forty-eight cases treated at Istituto Nazionale Tumori of Milan. Eur J Surg Oncol. 1993; Aug. 19(4):316–9.

16. Patel SG, Prasad ML, Escrig M, Singh B, Shaha AR, Kraus DH, et al. Primary mucosal malignant melanoma of the head and neck. Head Neck. 2002; Mar. 24(3):247–57.

17. Temam S, Mamelle G, Marandas P, Wibault P, Avril MF, Janot F, et al. Postoperative radiotherapy for primary mucosal melanoma of the head and neck. Cancer. 2005; Jan. 103(2):313–9.

18. Wagner M, Morris CG, Werning JW, Mendenhall WM. Mucosal melanoma of the head and neck. Am J Clin Oncol. 2008; Feb. 31(1):43–8.

19. Koivunen P, Bäck L, Pukkila M, Laranne J, Kinnunen I, Grenman R, et al. Accuracy of the current TNM classification in predicting survival in patients with sinonasal mucosal melanoma. Laryngoscope. 2012; Aug. 122(8):1734–8.

20. Sun CZ, Li QL, Hu ZD, Jiang YE, Song M, Yang AK. Treatment and prognosis in sinonasal mucosal melanoma: a retrospective analysis of 65 patients from a single cancer center. Head Neck. 2014; May. 36(5):675–81.

21. Hodi FS, O’Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010; Aug. 363(8):711–23.

22. Guo J, Si L, Kong Y, Flaherty KT, Xu X, Zhu Y, et al. Phase II, open-label, single-arm trial of imatinib mesylate in patients with metastatic melanoma harboring c-Kit mutation or amplification. J Clin Oncol. 2011; Jul. 29(21):2904–9.

23. Huang SF, Liao CT, Kan CR, Chen IH. Primary mucosal melanoma of the nasal cavity and paranasal sinuses: 12 years of experience. J Otolaryngol. 2007; Apr. 36(2):124–9.