Primary mucosal melanoma of the head and neck. Comparison of clinical presentation and histopathologic features of oral and sinonasal melanoma

We reviewed all cases of head and neck mucosal melanomas (HNMM) treated at Emory University and affiliated hospitals during a 20 year period and evaluate overall survival, recurrences and efficacy of treatment. Comparisons were made between sinonasal melanoma (SNM) and oral cavity melanoma (OCM) including clinical features, histopathologic features, treatment, and clinical outcomes. We analyzed pathologic features and clinical outcomes of 22 cases of primary SNM and eight cases of OCM treated at Emory University Hospital between 1986 and 2006. Sixteen patients were stage I (53%), nine patients were stage II (30%) and five patients were stage III (17%). Mean age was 67.5 years with a range from 32 to 85 years. Sixty percent were men and 92% were white. The average follow-up time was 22.1 months and the median was 15.5 months. The average delay between onset of symptoms and diagnosis was 5.6 months. Patients with SNM had a lower incidence of nodal metastasis at initial presentation when compared with OCM (22% vs. 50%) (p < .08). Surgical resection was the primary treatment and was performed in 27/30 patients (90%). Two patients with SNM and 1 patient with OCM, because of advanced stage at diagnosis had no treatment. Radiation was used in 50% (15) of the patients and radiation as postoperative therapy was administered to 44.8% (13) of the patients. The combination of surgery, radiation and adjuvant therapy was administered to 39.2% (11/2 8) of the patients. The recurrence rate at the time of closing this study was 43.3% (13 patients) with a mean time for development of recurrences of 13.1 months. Twenty-five patients (83%) died during the course of this study. Nineteen deaths (82%) corresponded to patients with SNM and six deaths (75%) to patients with OCM. The overall survival mean time was 21 months (median 12.5) with a range between 1 and 143 months. The 1, 2, 3, and 5 year survival rate for this study was 53.3%, 40%, 15% and 10%, respectively. The oral cavity was the location for the two patients still alive after 5 years. Although survival time correlated with Stage, particularly Stage 1, this was not statistically significant. Survival time did not correlate with surgery or adjuvant therapy. Statistically significant differences were noted between the pathologic features of OCM and SNM. These significant pathologic differences did not correlate with disease specific survival: OCM and SNM (median survival, 17 months vs. 12 months). Mucosal melanoma of the head and neck is a rare entity. Unfortunately, most patients present with advanced local disease. Local, regional recurrences and distant metastasis still occur despite the implementation of aggressive treatment, including surgery, radiation and adjuvant therapy. Despite significant pathologic differences between SNM and OCM, no survival advantage was seen.