Melanoma of the nose: prognostic factors, three-dimensional histology, and surgical strategies

The prominent position of the nose in the face accounts for its constant exposure to sunlight and thus its high incidence of malignant involvement. The aim of this prospective study was to define prognostic factors for nasal melanomas and to evaluate surgical strategies.

Forty-five patients with stage I/II melanoma were included. Malignant melanomas of the nose represented 0.8% of stage I/II cutaneous melanoma and 5.3% of head and neck melanoma (1983-2004). The median tumor thickness was 0.75 mm. Twenty-two of 33 Lentigo maligna melanomas (LMM) underwent three-dimensional (3D) histology in paraffin technique (i.e., micrographic surgery).

The 5 year disease-specific survival rate was 96%, and the 5 year recurrence-free survival rate was 93%. There were no statistically significant risk factors in the univariate analysis. LMMs that were removed with accompanying 3D histology were thinner than other histologic types (median 0.75 vs. 1.55 mm). Compared with conventional histology, using 3D histology made it possible to reduce the excision margins (median 5 vs. 10 mm). There was one lymph node recurrence after LMM with 3D histology. Of five sentinel lymph node biopsies (SLNB) there was no positive SLNB and no recurrence.

This is the largest study of nasal melanomas so far. Excision of LMM using 3D histology allowed the reduction of excision margins for better cosmesis and function. Our results do not permit conclusions regarding the prognostic impact of SLNB.