Mucosal Melanoma of the Head and Neck: Tata Memorial Hospital Experience
Vedang Murthy, Ashwini Budrukkar, Gupta Tejpal, Jai Prakash Agarwal, Suruchi Singh, Sarbani Ghosh-Laskar, Shubhda Kane, Anil K D'Cruz
Citation Information :
Murthy V, Budrukkar A, Tejpal G, Agarwal JP, Singh S, Ghosh-Laskar S, Kane S, D'Cruz AK. Mucosal Melanoma of the Head and Neck: Tata Memorial Hospital Experience. Int J Head Neck Surg 2010; 1 (3):141-145.
Primary 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.
Aims
To analyze and report the outcomes of primary head and neck mucosal melanomas treated at Tata Memorial Hospital.
Methods
Retrospective 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.
Results
42 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.
Conclusion
Primary 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.
The National Cancer Data Base report on cutaneous and noncutaneous melanoma: A summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 1998;83(8):1664-78.
Malignant mucosal melanoma of the head and neck. Review of literature and report of 14 patients. Cancer 1997;80:1373-86.
Mucosal melanoma of the head and neck: The impact of local control on survival. Laryngoscope 1994;104:121-26.
Optimal treatment and outcomes for head and neck mucosal melanoma. Am J Clin Oncol 2005;28(6):626-30.
What is the role of radiotherapy in the treatment of mucosal melanoma of the head and neck? Crit Rev Oncol Hematol 2008;65: 121-28.
Management of mucosal melanomas of the head and neck: Did we make any progress. Curr Opin Otolaryngol Head Neck Surg 2010;18:101-06.
Oral Oncol 2000;36:152-69.
Primary mucosal melanoma of the head and neck. Comparison of clinical presentation and histopathologic features of oral and sinonasal melanoma. Oral Oncol 2008;44:1039-46.
Mucosal melanoma of the nose and paranasal sinus: A contemporary experience from the MD. Anderson Cancer Centre. Cancer 2010;116:2215-23.
Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg 1970;172(5):902-08.
Mucosal melanomas of the head and neck. Ann Otol Rhinol Laryngol 1998;107: 626-30.
Oral mucosal melanomas: The WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology. Oral Radiol Endod 1997;83:672-79.
MRI of mucosal malignant melanoma of the head and neck. Int J Radiat Oncol Biol Phys 2004;60(2):358-64.
Noncutaneous malignant melanoma: A prognostic model from a retrospective multicentre study. BMC Cancer 2010;10:167.
Mucosal melanomas of the head and neck: The Princess Margaret Hospital experience. Head Neck 2008;30:1325-31.
Current management of mucosal melanoma of the head and neck. J Surg Oncol 2003;83:116-22.
Mucosal melanoma of the head and neck: Radiotherapy or surgery? J Otolaryngol Head Neck Surg 2010;39:385-92.
Mucosal melanoma of the head and neck. Clin Otolaryngol 1998;23: 107-16.
Primary mucosal malignant melanoma of the head and neck. Head Neck 2002;24:247-57.
A multi-institutional retrospective analysis of external radiotherapy for mucosal melanoma of the head and neck in Northern Japan. Int J Radiat Oncol Biol Phys 2004;59(2):495-500.
Postoperative radiotherapy for primary mucosal melanoma of the head and neck. Cancer 2005;103:313-19.
Radiotherapy in the treatment of mucosal melanoma of the upper aerodigestive tract: Analysis of 74 cases. A Rare Cancer Network study. Int J Radiat Oncol Biol Phys 2006;65(3):751-59.
Postoperative adjuvant radiation therapy in the treatment of primary head and neck mucosal melanomas. ORL 2008;70:344-51.
Head and neck mucosal melanoma: Experience with 42 patients with special emphasis on the role of postoperative radiotherapy. Head-Neck 2008;30:1543-51.
Radiotherapy after surgical resection for head and neck mucosal melanoma. Am J Clin Oncol 2010;33:281-85.
The radiosensitivity of melanoma cells in culture. Br J Radiol 1971;44:816-17.
Clinical radiobiology of malignant melanoma. Radiother Oncol 1989;16:169-82.
Mucosal melanoma of the head and neck treated with carbon ion radiotherapy. Int J Radiat Oncol Biol Phys 2009;74:15-20.
Adjuvant immunotherapy for patients with melanoma: Are patients with melanoma of the head and neck candidates for this therapy? Head-Neck 1997;19:595-603.
Biochemotherapy in patients with advanced head and neck mucosal melanoma. Head-Neck 2008;30;1592-98.