Breik Omar, Sim Felix, Wong Tim, Nastri Alf, Iseli Tim A, Wiesenfeld David
Registrar, Department of Oral and Maxillofacial Surgery, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Head and Neck Fellow, Head and Neck Tumour Stream, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
J Oral Maxillofac Surg. 2016 Sep;74(9):1859-71. doi: 10.1016/j.joms.2016.03.008. Epub 2016 Mar 17.
Malignant mucosal melanoma of the head and neck (MMHN) is an aggressive and rare neoplasm with poor long-term outcomes. The aim of this study is to evaluate the outcomes of patients treated by a single-institution head and neck multidisciplinary team.
In this retrospective case series, all MMHN cases treated at the Royal Melbourne Hospital from 1990-2015 were retrospectively reviewed. Patient demographic characteristics (eg, age), treatment offered, pathology, and outcomes were collected, tabulated, and correlated with outcomes. Survival outcomes were calculated by the Kaplan-Meier method. Comparison was made between oral and sinonasal melanomas.
A total of 16 cases were identified. Two were excluded because of inaccessible data. Of the 14 remaining cases, 8 were sinonasal melanomas and 6 were oral cavity melanomas. Sinonasal tumor patients presented with epistaxis or visual impairment. Oral melanoma patients presented with pigmented lesions or ulceration. Follow-up ranged from 4 months to 11 years. In 2 patients, locoregional recurrences developed that were successfully re-excised. Six patients died of distant metastases despite clear surgical margins. Two patients with sinonasal melanomas died of extensive local disease with intracranial invasion. One patient died 4 years after diagnosis without disease. There were no failures in the neck. The 2- and 5-year overall survival rates were 63.3% and 31.7%, respectively, by the Kaplan-Meier method. The difference in survival between oral and sinonasal melanomas was not statistically significant.
Despite clear surgical margins, MMHN has a poor prognosis and most deaths are due to distant metastases. Systemic therapies such as those used in cutaneous melanoma treatment might be used in the future for MMHN.
头颈部恶性黏膜黑色素瘤（MMHN）是一种侵袭性强且罕见的肿瘤，长期预后较差。本研究旨在评估由单一机构的头颈部多学科团队治疗的患者的预后情况。
在这个回顾性病例系列中，对1990年至2015年在皇家墨尔本医院接受治疗的所有MMHN病例进行了回顾性分析。收集患者的人口统计学特征（如年龄）、所接受的治疗、病理及预后情况，制成表格并与预后相关联。生存预后采用Kaplan-Meier方法计算。对口腔和鼻窦黑色素瘤进行了比较。
共识别出16例病例。2例因数据无法获取而被排除。其余14例中，8例为鼻窦黑色素瘤，6例为口腔黑色素瘤。鼻窦肿瘤患者表现为鼻出血或视力障碍。口腔黑色素瘤患者表现为色素沉着病变或溃疡。随访时间为4个月至11年。2例患者出现局部区域复发，经再次切除成功治愈。6例患者尽管手术切缘清晰，但仍死于远处转移。2例鼻窦黑色素瘤患者死于伴有颅内侵犯的广泛性局部疾病。1例患者在诊断后4年无疾病死亡。颈部未出现复发。采用Kaplan-Meier方法计算的2年和5年总生存率分别为63.3%和31.7%。口腔和鼻窦黑色素瘤在生存率上的差异无统计学意义。
尽管手术切缘清晰，但MMHN预后较差，大多数死亡是由于远处转移。未来可能会将用于皮肤黑色素瘤治疗的全身治疗方法用于MMHN。
