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Sinonasal Mucosal Melanoma: A Comprehensive Review and Clinical Experience
Dongyoung Kim1, Seung-No Hong2
1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Abstract:
Sinonasal malignant melanoma is an extremely rare and aggressive malignancy. Diagnosis is often delayed because of nonspecific symptoms and complex histopathology. The primary treatment is surgical resection, with adjuvant radiotherapy frequently employed, although its survival benefit remains controversial. Systemic therapies, including immunotherapy and targeted therapy, show limited efficacy compared with cutaneous melanoma, partly due to distinct genetic profiles. The authors present the experience of a single-referral center with 10 patients diagnosed with sinonasal malignant melanoma. Despite treatment, which primarily involved surgery with adjuvant radiotherapy (n=7), outcomes were poor, with frequent recurrence and metastasis. Only one patient who achieved clear surgical margins and received adjuvant radiotherapy remained disease-free for more than five years. Based on these data, achieving clear surgical margins and establishing an early diagnosis are critical prognostic factors in the treatment of sinonasal mucosal melanoma. Management of this condition remains challenging, and no standardized treatment protocol has been established. Continued investigation and research are imperative to develop definitive therapeutic approaches.
Insights
Sinonasal malignant melanoma is rare and aggressive. Achieving clear surgical margins and early diagnosis are critical for improving outcomes in this challenging cancer.
Area of Science:
- Oncology
- Head and Neck Surgery
Background:
- Sinonasal malignant melanoma is a rare, aggressive cancer.
- Diagnosis is often delayed due to nonspecific symptoms and complex pathology.
- Current treatments like surgery and radiotherapy have limited, controversial survival benefits.
Purpose of the Study:
- To present the clinical experience with sinonasal malignant melanoma at a single referral center.
- To identify critical prognostic factors for treatment of this rare malignancy.
Main Methods:
- Retrospective review of 10 patients diagnosed with sinonasal malignant melanoma.
- Analysis of treatment modalities including surgery and adjuvant radiotherapy.
- Evaluation of patient outcomes, recurrence, and metastasis.
Main Results:
- Outcomes were generally poor despite treatment, with frequent recurrence and metastasis.
- Only one patient with clear surgical margins and adjuvant radiotherapy achieved long-term disease-free survival.
- Clear surgical margins and early diagnosis emerged as critical prognostic factors.
Conclusions:
- Achieving clear surgical margins is vital for successful sinonasal malignant melanoma treatment.
- Early diagnosis significantly impacts patient prognosis.
- Management remains challenging, necessitating further research for standardized protocols.
