Abstract
Background Sinonasal melanoma is a rare disease with a high mortality rate. The surgical management
paradigm has significantly changed over the past decade with the introduction of expanded
endonasal techniques. There have also been advances in management of metastatic and
locally advanced disease with the advent of immunotherapy.
Methods Single-institution retrospective review of adult patients with sinonasal melanoma,
surgically managed at the University of Michigan over a 9-year period. Thirty-one
patients met inclusion criteria. All patients were retrospectively staged according
to the 7th Edition AJCC staging system for mucosal melanoma. Parameters that may affect
survival were analyzed using Cox's proportional hazard models and survival outcomes
were analyzed with the Kaplan–Meier method. Additionally, a review of three patients
with distant metastatic disease receiving immunotherapy is presented.
Results Most patients were managed endoscopically (67%), and had stage III disease (71%).
However, 57% of stage IVB tumors were successfully managed endoscopically. Stage statistically
impacted overall survival whereas distant control was impacted by stage, site of origin,
mitotic rate, and necrosis. The 2-year overall survival for all stages was 77% which
declined with advanced disease. Two-year locoregional control and distant control
showed similar trends.
Conclusion Treatment of sinonasal melanoma has drastically changed over the past decade with
increased use of expanded endonasal techniques. Our review revealed excellent 2-year
overall survival in stage III disease with an appreciable decline in survival in more
advanced disease. Immunotherapy may play a large role is future management given the
high-risk of distant metastasis.
Keywords
sinonasal malignancy - mucosal melanoma - outcomes - immunotherapy - expanded endonasal
technique
