Vol.96 No.2 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 96 No. 2 February 2003
Sinonasal Malignant Melanoma; Clinical Analysis of 14 Cases
Masamitsu Hyodo, Hidemitsu Sato, Takahiko Yamagata and Naohito Hato
(Ehime University)
Hiroshi Aritomo
(Matsuyama Red Cross Hospital)
Malignant melanoma arising from the mucosa of the nasal cavity and paranasal sinuses is a rare disease with a generally poor prognosis. Clinical data on 14 patients were analyzed in a retrospective manner. They consisted of 4 males and 10 females, and their mean age was 63.6 years (range 46-74). All patients complained of recurrent epistaxis. Primary tumor sites were the nasal cavity in 12 patients and paranasal sinuses in 2. Immunohistochemical staining for HMB-45, S-100 protein and vimentin was considered necessary for differential diagnosis, especially in amelanotic melanoma. In 12 patients, treatment involved radical surgery with or without adjuvant chemotherapy. However, all 12 patients developed local recurrence. The disease-specific survival was 38.5％ at 2 years, 20.5％ at 5 years, and 10.2％ at 10 years. Eight patients died of distant metastasis and 4 died of local failure, suggesting distant metastasis as the limiting factor for long-term survival. Patients who underwent craniofacial surgery for local disease had significantly better survival than those who did not. Repetitive chemotherapy tended to improve the prognosis, however, the difference was not significant. This study shows that wide local resection appears to have the best efficacy in managing sinonasal melanoma, and adjuvant chemotherapy and radiotherapy may have benefit for increasing disease control.
Key words : malignant melanoma, nasal cavity and paranasal sinus, immunohistochemical staining, radical surgery, adjuvant chemotherapy