Mucosal Melanomas of the Head and Neck
Slavíček A., Astl J., Válková D., Betka J., Petruželka L.
Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN Motol, Praha, katedra IPVZ, Praha, přednosta prof. MUDr. J. Betka, DrSc., Praha Onkologická klinika 1. LF UK a VFN, Praha, přednosta doc. MUDr. L. Petruželka, CSc. |
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Summary:
Mucosal melanomas are as compared with melanomas of the skin relatively rare. Only
0.5 - 2% of all melanomas are on mucous membranes. In the area of the head and neck this applies
in particular to the area of the nasal cavity and paranasal sinuses and the oral cavity. The chief
therapeutic procedure is radical removal of the tumour, but the presence of tumours in these areas
makes surgical excision difficult. Surgical treatment is followed by actinotherapy, possibly immu-
nochemotherapy.
Due to the small number of hitherto published papers reporting on very small groups of patients,
or rather a few cases, the concept of treatment is far from uniform. In the submitted report the
authors analyzed the clinical course of the disease in 17 patients who developed a mucosal melanoma in the area of the head and neck during the period of 1980 - 1998. They made a retrospective
analysis of the course of the disease, of lymphogenic and haematogenic secondaries and the type of
treatment. The tumour was six times on the lateral nasal wall, fourtimes on the septum and one case
each in the maxillary sinus, the ethmoidal sinus, the epipharynx, in the lacrimal sac in the tonsill
and in twice the hypopharynx.
From the total number of 17 patients 10 were treated primarily by surgery, one by radiotherapy and
three by chemotherapy. In three patients only diagnostic surgery was performed. Primarily the
operation was supplemented in two patients by cervical bloc dissection. Surgical treatment was
followed by actinotherapy and in three cases by chemotherapy. After primary radiotherapy surgical
treatment with subsequent chemotherapy was indicated. Primary chemotherapy was followed
twice by surgical treatment. In the total number of nine recurrences the authors selected as
a further therapeutic modality five times surgery and four times chemotherapy. When chemotherapy was indicated it was as a rule combined with Khayat’s immunotherapy. In some instances other
cytostatics were administered, or combinations of cytostatics. From the total number 40% patients
survive for longer than three years, regardless of the provided treatment.
Key words:
malignant melanoma, mucosal melanoma.
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