Melanoma and Skin Service and Head and Neck Service, Division of Surgical Oncology, Department of Surgical Oncology, Peter MacCallum Cancer Center, Melbourne, Australia.
Melanoma Res. 2011 Aug;21(4):257-66. doi: 10.1097/CMR.0b013e3283470ffd.
Head and neck mucosal melanoma (MM) is a rare and aggressive neoplasm, with high rates of local, regional, and distant failure. Owing to the small size of most reported series and their retrospective nature, and the lack of uniform comprehensive staging system, the effect of various treatment strategies on disease control and survival has been difficult to assess. The optimal management of head and neck MM is not well defined. Surgical treatment has being advocated as the primary treatment modality, with growing consideration for postoperative radiotherapy, as wide surgical resection in the head and neck region is often difficult. Radiotherapy is recently reported as a beneficial management modality, regardless of the fact that MM has been considered to be radioresistant. As significant morbidity is expected in high doses of radiotherapy to the head and neck region, new radiographic modalities with better precision are required. Furthermore, high-energy radiotherapy was suggested as a better therapy to mucosal MM due to the suggested biology of the tumor. The high rates of locoregional recurrence and distant metastasis also suggest that a systemic treatment is needed. Currently, there is no role for adjuvant systemic therapy for patients who have been successfully resected, but recent developments in the understanding of the biology of melanoma and, in particular, specific growth pathways holds promise for the future. We strongly recommend further evaluation of the role of chemotherapy and immunotherapy to decrease the rates of distant metastasis and improve survival.
头颈部黏膜黑色素瘤（MM）是一种罕见且侵袭性很强的肿瘤，局部、区域和远处失败的发生率很高。由于大多数报道的系列研究规模较小且为回顾性，以及缺乏统一的综合分期系统，因此各种治疗策略对疾病控制和生存的影响难以评估。头颈部 MM 的最佳治疗方法尚未明确。手术治疗被认为是主要的治疗方式，越来越多的人考虑术后放疗，因为在头颈部进行广泛的手术切除往往很困难。放疗最近被报道为一种有益的治疗方式，尽管 MM 被认为对放疗有抗性。由于头颈部区域高剂量放疗预计会产生显著的发病率，因此需要具有更好精度的新型放射模式。此外，由于肿瘤的生物学特性，高能放疗被认为是黏膜 MM 的更好疗法。高的局部区域复发和远处转移率也表明需要进行全身治疗。目前，对于成功切除的患者，辅助全身治疗没有作用，但最近对黑色素瘤生物学的理解，特别是对特定生长途径的理解，为未来带来了希望。我们强烈建议进一步评估化疗和免疫疗法的作用，以降低远处转移率并提高生存率。
