Manolidis S, Donald P J
Department of Otolaryngology-Head and Neck Surgery and Pharmacology, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Cancer. 1997 Oct 15;80(8):1373-86. doi: 10.1002/(sici)1097-0142(19971015)80:8<1373::aid-cncr3>3.0.co;2-g.
Fortunately, primary malignant mucosal melanoma of the head and neck is a rare entity. A paucity of data elucidating the predictive factors as well as the unpredictable and aggressive biologic behavior of mucosal melanoma compound the vexing clinical situation. This review summarizes what the literature reveals about the epidemiology, patient survival, patterns of local recurrence, and local and distant metastasis of the disease. Over 1000 patients with this disease have been reported. Survivals at 5 and 10 years is 17% and 5%, respectively. Approximately 19% of patients present with lymph node metastasis and another 16% develop lymph node metastases after treatment, whereas 10% present with distant metastasis. Local metastasis does not affect survival; this is in sharp contrast with skin melanoma. Over 50% of patients experience local treatment failure, and salvage treatment is effective in only 25% of these cases. Local failure is the harbinger of distant metastases. Patients with nasal mucosal melanoma have a 31% 5-year survival rate, whereas sinus melanoma patients fare poorly, with a 0% rate of 5-year survival.
The authors conducted a retrospective review of 14 patients with characteristics similar to those in the literature in terms of outcome.
The 5-year survival rate for these patients was 14%. Whole-body positron emission tomography was performed on 3 patients to detect metastatic disease. The patterns of local recurrence, distant metastasis, and survival for these patients were compared with the same data for patients described in the literature.
Surgery appears to have the greatest efficacy in the management of mucosal melanoma, although radiation therapy may play an increasingly important role in the future.
幸运的是，头颈部原发性恶性黏膜黑色素瘤是一种罕见的疾病。由于缺乏阐明预测因素的数据，以及黏膜黑色素瘤不可预测且具有侵袭性的生物学行为，使得临床情况更加棘手。本综述总结了文献中关于该疾病的流行病学、患者生存率、局部复发模式以及局部和远处转移的情况。已有超过1000例该疾病患者的报道。5年和10年生存率分别为17%和5%。约19%的患者出现淋巴结转移，另有16%的患者在治疗后发生淋巴结转移，而10%的患者出现远处转移。局部转移不影响生存率；这与皮肤黑色素瘤形成鲜明对比。超过50%的患者经历局部治疗失败，挽救性治疗仅在其中25%的病例中有效。局部失败是远处转移的先兆。鼻黏膜黑色素瘤患者的5年生存率为31%，而鼻窦黑色素瘤患者预后较差，5年生存率为0%。
作者对14例在结局方面与文献中特征相似的患者进行了回顾性研究。
这些患者的5年生存率为14%。对3例患者进行了全身正电子发射断层扫描以检测转移性疾病。将这些患者的局部复发、远处转移和生存模式与文献中描述的患者的相同数据进行了比较。
手术似乎在黏膜黑色素瘤的治疗中疗效最佳，尽管放射治疗未来可能会发挥越来越重要的作用。
