Outcomes of sinonasal mucosal melanomas with endoscopic and open resection: a retrospective cohort study
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CLINICAL STUDY
Outcomes of sinonasal mucosal melanomas with endoscopic and open resection: a retrospective cohort study Deema M. Almutuawa1 · Madeleine P. Strohl1 · Calvin Gruss2 · Annemieke van Zante3 · Sue S. Yom4 · Michael W. McDermott5 · Ivan H. El‑Sayed6 Received: 18 January 2020 / Accepted: 4 March 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To compare the outcomes of Sinonasal Mucosal Melanomas (SNMM) treated with endoscopic and open resection. Methods A retrospective case review of 20 patients with SNMM treated surgically at UCSF. Kaplan–Meier analyses were calculated to determine outcome differences in endoscopic vs. open resections. Results From 2005 to 2014, 20 cases of SNMM were confirmed and treated at UCSF. All cases underwent surgical resection, with 10 cases by open resection and 10 cases by endoscopic resection. Using Kaplan–Meier analyses, the open resection group had a 1-year survival of 30% whereas endoscopic resection group was 80% (p = 0.032). Endoscopic resection showed improved survival at all time points after surgery compared to open resection. Conclusion SNMM is a rare and aggressive tumor that is associated with low survival rates. In this small case series, endoscopic resection had improved survival outcomes compared to open resection. Keywords Sinonasal mucosal melanoma · Endoscopic resection
Introduction Sinonasal malignant melanoma (SNMM) is a rare neoplasm, arising from melanocytes of neural crest origin. SNMM accounts for less than 1% of all malignant melanomas [1–3]. These tumors are very aggressive with a 5-year survival * Ivan H. El‑Sayed Ivan.el‑[email protected] 1
Department of Otolaryngology‑Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, USA
2
Department of Anesthesiology, Vanderbilt University, Nashville, TN, USA
3
Department of Pathology, University of California-San Francisco, San Francisco, CA, USA
4
Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
5
Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA
6
Department of Otolaryngology‑Head and Neck Surgery, Center for Minimally Invasive Skull Base Surgery, University of California-San Francisco, 2233 Post St, 3rd Floor, San Francisco, CA 94115, USA
reported under 25% [4] About 80% of patients present with localized disease, typically involving the nasal cavity. However, regional and distant metastatic spread occurs in about 45% of patients[1]. Shielded from ultraviolet radiation exposure in the sinonasal cavity, SNMM appears to have different biology than melanoma of cutaneous origin. Approximately 20% of cases are multifocal at presentation and 40% have amelanotic histology [1] Sinonasal tumors are typically diagnosed at an advanced stage and larger size due to the paucity of symptoms in early stages and being hidden from view. Two staging systems have been proposed. Ballantyne’s traditional staging system classifies tumors
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