J Neurol Surg B Skull Base 2013; 74 - A018
DOI: 10.1055/s-0033-1336151

Endoscopic Surgery for Sinonasal Mucosal Melanoma

Andrew M. Rivera 1(presenter), Seth M. Lieberman 1, Roy R. Casiano 1
  • 1Miami Beach, FL, USA

Objective: To review our clinical experience in the management of sinonasal mucosal melanoma using minimally invasive surgical techniques.

Design: Retrospective chart review of patients undergoing endoscopic resection of sinonasal mucosal melanoma.

Setting: Tertiary care referral center.

Main Outcome Measures: Charts were reviewed for clinical presentation, disease stage, intraoperative findings, use of adjuvant treatment, and clinical outcomes (postoperative complications, locoregional control, disease-specific survival, and recurrence-free survival). Survival data were evaluated with Kaplan-Meier survival analysis.

Results: Twelve patients underwent endoscopic resection of sinonasal mucosal melanoma between 1992 and 2012. This cohort included six men and six women with a median age of 77 years (range, 53 to 91years). Mean length of follow-up was 25.13 months (range, 0.5 to 61 months). On initial presentation, by American Joint Committee on Cancer staging for mucosal melanoma, seven patients were stage IVA (T4aN0-1MO), two patients were stage IVB (T4bN0M0), two patients were stage III (T3N0M0), and one patient had intranasal metastatic disease. The primary site of tumor origin was the ethmoid sinus in 33% (4/12), septum in 33% (4/12), inferior turbinate in 16% (2/12), middle turbinate in 16% (1/12), and maxillary sinus in 1 patient. Endoscopic procedures included medial maxillectomy (8), total ethmoidectomy (6), septectomy (5), and total and anterior skull base resection (3), depending on the primary site. The rate of cerebrospinal fluid leak was 25% (3/12). Adjuvant therapy was used in 50% of patients with 33% receiving radiation, 25% receiving chemotherapy with radiation, and 16% receiving immunotherapy. The local recurrence rate was 50%. Overall disease-free survival was 91.6% at 12 months and 60% at 24 months.

Conclusion: For appropriately selected patients, endoscopic resection of sinonasal mucosal melanoma is a viable intervention for this aggressive disease entity.