Malignant Melanoma in the ENT Area

Overview

Malignan melanoma (MM) is one of the rare tumours, although its incidence is risingby 4 - 5 % p.a. Some 20 % melanomas are in the area of the head and neck. The mucosal form is theleast frequent and accounts for 1.4 % of all MM. There are differences in the geographical incidence.In the Czech Republic the contemporary incidence is 10.2/100 000 population (8). Consistent withthe low incidence, also the number of publications is small. Treatment of these tumours is contro-versial - using surgery, actinotherapy, immunochemotherapy and a combination of all techniques.The prognosis is poor, five-year survival varies between 15 - 30 %.The present study on mucosal melanomas of the ENT area and ENT skin area is retrospective, basedon health records of 25 patients treated at the ENT and Head and Neck Surgical Clinic of the FacultyHospital in Motol and First Medical Faculty Charles University and the Chair of PostgraduateMedical Training in Prague between 1990 and 1998. The health status was assessed by contact inwriting, by phone or personal contact with the patient or his family. The group comprised 14 womenand 11 men, mean age 62 years, range 19 - 85 years. There were 11 skin melanomas, three times onthe outer nose, five times on the ear lobe, three times on the eyelid and in the temporal region. Threetimes cervical metastases of melanomas with a primary localization elsewhere were involved. Therewere 11 mucosal melanomas with a predominance of nasal ones —9- and two in the pharynx. Themethod of choice in all patients was surgery which was four times followed by actinotherapy, fourtimes by immunochemotherapy and fives times by a combination of the two methods. The mostfrequently used pattern of chemotherapy was that of Khayat: cycloplatinun 600 mg i.v. + Intron A 5million u. s.c. three times per week + Proleukin 1 vial s.c./day. A total of six cycles after three-weekintervals. Actinotherapy was applied fractionated, 8 Gy once per week up to a total dose of 32 Gy.Block dissection was performed in one patient with mucosal and seven patients with skin melanoma.Five-year survival in the entire group was recorded in 30 % patients, in the group of skin melanomasin 27 %, in the group of mucosal melanomas in 33 %. Although in the literature a poorer prognosisof mucosal forms is reported, this was not the case in our group. We detected melanoms of “twospeeds”. Some fulminant, rapidly metastatizing, and conversely melanomas of local tropism, witha local relapse but long-term survival.

Key words:
malignant melanoma, mucosal melanoma, nasal cavity, pharynx, tonsil, immuno-