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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Updates in the management of sinonasal mucosal melanoma
Meghan M Crippen1, Suat Kılıç1, Jean A Eloy1,2,3,4
1Department of Otolaryngology - Head and Neck Surgery.
Purpose Of Review:
Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with a poor prognosis. Although there is significant study surrounding the treatment of sinonasal malignancies and cutaneous melanomas, the rarity of this tumor has largely precluded robust outcomes analyses. The authors of this review seek to provide an overview of the recent literature related to the treatment of SNMM with added context from our institutional experience with this disease.
Recent Findings:
In the surgical management of sinonasal malignancies and SNMM specifically, resection via endoscopic endonasal technique appears to offer comparable oncologic outcomes versus an open approach. The role of adjuvant therapy continues to be debated, but there is strong evidence for improved rates of local control with radiotherapy after complete resection. In the last few years, significant developments have been made in the study of systemic therapies for cutaneous melanoma. The identification of genetic mutations common to mucosal melanoma has allowed for early trials of targeted therapies, but study is ongoing.
Summary:
Although the study of SNMM is largely limited to small retrospective case series, treatment continues to evolve. Until effective systemic therapies can be identified, endoscopic resection with adjuvant radiotherapy may offer the best disease-free survival with acceptably low morbidity.
Insights
Sinonasal mucosal melanoma (SNMM) treatment is evolving. Endoscopic resection with radiotherapy offers the best survival rates for this rare cancer, pending effective systemic therapies.
Area of Science:
- Oncology
- Head and Neck Surgery
- Melanoma Research
Background:
- Sinonasal mucosal melanoma (SNMM) is an aggressive malignancy with a poor prognosis.
- Limited data exists due to the rarity of SNMM, hindering robust outcomes analysis.
- Existing research often focuses on sinonasal malignancies broadly or cutaneous melanomas.
Purpose of the Study:
- To provide an overview of recent literature on SNMM treatment.
- To incorporate institutional experience with SNMM into the review.
- To address the challenges posed by the rarity of SNMM in outcomes research.
Main Methods:
- Review of recent literature on sinonasal mucosal melanoma treatment.
- Analysis of institutional experience with SNMM.
- Comparison of surgical approaches (endoscopic vs. open) and adjuvant therapies.
Main Results:
- Endoscopic endonasal resection shows comparable oncologic outcomes to open approaches for SNMM.
- Radiotherapy following complete resection demonstrates improved local control rates.
- Systemic therapies for cutaneous melanoma are advancing, with early trials for SNMM targeting identified genetic mutations.
Conclusions:
- SNMM treatment is evolving, primarily based on small retrospective studies.
- Endoscopic resection combined with adjuvant radiotherapy may optimize disease-free survival.
- Further research is needed to identify effective systemic therapies for SNMM.
