Management of mucosal melanomas of the head and neck: did we make any progress?

Primary mucosal melanoma of the head and neck is a rare tumor associated with a poor outcome. This diagnosis carries a great deal of anxiety for the patients and puts the clinician in a predicament to find concise and reliable information for adequate risk stratification and treatment.

Sinonasal mucosal melanomas should be staged according to the tumor node metastasis staging system and could be treated endoscopically with similar results to open surgery. Prophylactic neck dissection could be indicated in oral melanomas, given their tendency to regional failure. Adjuvant radiotherapy improves locoregional control in several series but does not improve survival. Definitive radiation with high linear energy transfer modalities achieves locoregional control rates comparable to surgery. Biochemotherapy improves survival in mucosal melanoma of the head and neck and should be considered for patients with metastatic or extensive locoregional disease.

The standard therapy for melanoma continues to be surgical resection, possibly associated with adjuvant radiation. Biochemotherapy should be considered for bulky metastatic disease. In the future, definitive radiation regimes, molecular staging and targeted therapy may play a major role.