Sinonasal Melanoma: A Single Institutional Analysis and Future Directions

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

• References

• 1 Chang AE, Karnell LH, Menck HR. ; The American College of Surgeons Commission on Cancer and the American Cancer Society. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. Cancer 1998; 83 (08) 1664-1678
• 2 Shah JP, Huvos AG, Strong EW. Mucosal melanomas of the head and neck. Am J Surg 1977; 134 (04) 531-535
• 3 Prasad ML, Patel S, Hoshaw-Woodard S. , et al. Prognostic factors for malignant melanoma of the squamous mucosa of the head and neck. Am J Surg Pathol 2002; 26 (07) 883-892
• 4 Lund VJ, Howard DJ, Harding L, Wei WI. Management options and survival in malignant melanoma of the sinonasal mucosa. Laryngoscope 1999; 109 (2 Pt 1): 208-211
• 5 Gaze MN, Kerr GR, Smyth JF. ; The Scottish Melanoma Group. Mucosal melanomas of the head and neck: The Scottish experience. Clin Oncol (R Coll Radiol) 1990; 2 (05) 277-283
• 6 Stern SJ, Guillamondegui OM. Mucosal melanoma of the head and neck. Head Neck 1991; 13 (01) 22-27
• 7 Suh JD, Ramakrishnan VR, Chi JJ, Palmer JN, Chiu AG. Outcomes and complications of endoscopic approaches for malignancies of the paranasal sinuses and anterior skull base. Ann Otol Rhinol Laryngol 2013; 122 (01) 54-59
• 8 Nicolai P, Battaglia P, Bignami M. , et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol 2008; 22 (03) 308-316
• 9 Lund V. Malignant melanoma of the nasal cavity and paranasal sinuses. J Laryngol Otol 1982; 96 (04) 347-355
• 10 Hodi FS, O'Day SJ, McDermott DF. , et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 2010; 363 (08) 711-723
• 11 Robert C, Thomas L, Bondarenko I. , et al. Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med 2011; 364 (26) 2517-2526
• 12 Robert C, Long GV, Brady B. , et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med 2015; 372 (04) 320-330
• 13 Weber JS, D'Angelo SP, Minor D. , et al. Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment (CheckMate 037): a randomised, controlled, open-label, phase 3 trial. Lancet Oncol 2015; 16 (04) 375-384
• 14 Dummer R, Daud A, Puzanov I. , et al. A randomized controlled comparison of pembrolizumab and chemotherapy in patients with ipilimumab-refractory melanoma. J Transl Med 2015; 13 (Suppl 1:O5
• 15 Larkin J, Chiarion-Sileni V, Gonzalez R. , et al. Combined Nivolumab and Ipilimumab or monotherapy in untreated melanoma. N Engl J Med 2015; 373 (01) 23-34
• 16 Postow MA, Luke JJ, Bluth MJ. , et al. Ipilimumab for patients with advanced mucosal melanoma. Oncologist 2013; 18 (06) 726-732
• 17 Postow MA, Hamid O, Carvajal RD. Mucosal melanoma: pathogenesis, clinical behavior, and management. Curr Oncol Rep 2012; 14 (05) 441-448
• 18 Moreno MA, Roberts DB, Kupferman ME. , et al. Mucosal melanoma of the nose and paranasal sinuses, a contemporary experience from the M. D. Anderson cancer center. Cancer 2010; 116 (09) 2215-2223
• 19 Benlyazid A, Thariat J, Temam S. , et al. Postoperative radiotherapy in head and neck mucosal melanoma: a GETTEC study. Arch Otolaryngol Head Neck Surg 2010; 136 (12) 1219-1225
• 20 Shiga K, Ogawa T, Kobayashi T. , et al. Malignant melanoma of the head and neck: a multi-institutional retrospective analysis of cases in northern Japan. Head Neck 2012; 34 (11) 1537-1541
• 21 Temam S, Mamelle G, Marandas P. , et al. Postoperative radiotherapy for primary mucosal melanoma of the head and neck. Cancer 2005; 103 (02) 313-319
• 22 Krengli M, Jereczek-Fossa BA, Kaanders JH, Masini L, Beldì D, Orecchia R. What is the role of radiotherapy in the treatment of mucosal melanoma of the head and neck?. Crit Rev Oncol Hematol 2008; 65 (02) 121-128
• 23 Bachar G, Loh KS, O'Sullivan B. , et al. Mucosal melanomas of the head and neck: experience of the Princess Margaret Hospital. Head Neck 2008; 30 (10) 1325-1331