Crippen Meghan M, Kılıç Suat, Eloy Jean A
Department of Otolaryngology - Head and Neck Surgery.
Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey.
Curr Opin Otolaryngol Head Neck Surg. 2018 Feb;26(1):52-57. doi: 10.1097/MOO.0000000000000428.
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.
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.
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.
鼻窦黏膜黑色素瘤（SNMM）是一种侵袭性癌症，预后较差。尽管围绕鼻窦恶性肿瘤和皮肤黑色素瘤的治疗有大量研究，但这种肿瘤的罕见性在很大程度上阻碍了有力的疗效分析。本综述的作者旨在概述近期与SNMM治疗相关的文献，并结合我们机构对该疾病的治疗经验提供更多背景信息。
在鼻窦恶性肿瘤尤其是SNMM的手术治疗中，经鼻内镜技术切除与开放手术相比似乎能提供相当的肿瘤学疗效。辅助治疗的作用仍存在争议，但有强有力的证据表明，完全切除后放疗可提高局部控制率。在过去几年中，皮肤黑色素瘤的全身治疗研究取得了重大进展。黏膜黑色素瘤常见基因突变的鉴定使得靶向治疗的早期试验成为可能，但研究仍在进行中。
尽管SNMM的研究主要限于小型回顾性病例系列，但治疗方法仍在不断发展。在确定有效的全身治疗方法之前，内镜切除联合辅助放疗可能提供最佳的无病生存期，且发病率可接受地低。
