title: Craniofacial resection for malignant melanoma of the skull base: report of an international collaborative study.
abstract: OBJECTIVE
  To report postoperative mortality, complications, and outcomes in a subset of patients with the histologic diagnosis of malignant melanoma extracted from an existing database of a large cohort of patients accumulated from multiple institutions.
  
  
  METHODS
  Retrospective outcome analysis.
  
  
  METHODS
  Seventeen international tertiary referral centers performing craniofacial surgery for malignant skull base tumors.
  
  
  METHODS
  A total of 53 patients were identified from a database of 1307 patients who had craniofacial resection for malignant tumors at 17 institutions. The median age was 63 years. Of the 53 patients, 25 (47%) had had prior single modality or combined treatment, which included surgery in 22 (42%), radiation in 11 (21%), and chemotherapy in 2 (4%). The margins of resection were close or microscopically positive in 7 (13%). Adjuvant radiotherapy was given in 22 (42%), chemotherapy in 3 (6%), and vaccine or interferon therapy in 2 (4%). Complications were classified into overall, local, central nervous system, systemic, and orbital. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined using the Kaplan-Meier method. Predictors of outcome were identified by multivariate analysis.
  
  
  RESULTS
  Postoperative mortality occurred in 3 patients (6%) and postoperative complications were reported in 14 patients (26%). Local wound complications occurred in 6 patients (11%), central nervous system in 7 (13%), systemic in 3 (6%), and orbital in 1 (2%). With a median follow-up of 10 months (range, 1-159 months), the 3-year OS, DSS, and RFS rates were 28.2%, 29.7%, and 25.5%, respectively. The extent of orbital involvement and adjuvant postoperative radiation therapy (PORT) were independent predictors of DSS and OS on multivariate analysis, whereas only PORT was an independent predictor of RFS. Patients treated with PORT had significantly better 3-year OS (39% vs 18%; relative risk, 2.9; P = .007), DSS (41% vs 19%; relative risk, 3.0; P = .007), and RFS (39% vs 15%; relative risk, 4.2; P = .001).
  
  
  CONCLUSIONS
  Craniofacial resection in patients with malignant melanoma of the skull base has mortality (6%) and complication rates (26%) comparable to other malignant tumors of the skull base. However, malignant melanoma is associated with a much poorer OS, DSS, and RFS. Adjuvant PORT correlated with improved 3-year OS, DSS, and RFS on multivariate analysis. These factors must be taken into account when considering craniofacial resection in a patient with malignant melanoma invading the skull base.
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Bhuvanesh
authors.initials: B
authors.lastname: Singh
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Bridger
authors.forename: Giulo
authors.initials: G
authors.lastname: Cantu
authors.forename: Anthony
authors.initials: A
authors.lastname: Cheesman
authors.forename: Geraldo
authors.initials: G
authors.lastname: De Sa
authors.forename: Paul
authors.initials: P
authors.lastname: Donald
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
authors.forename: Patrick
authors.initials: P
authors.lastname: Gullane
authors.forename: Ivo
authors.initials: I
authors.lastname: Janecka
authors.forename: Shin-Etsu
authors.initials: SE
authors.lastname: Kamata
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.forename: Paul A
authors.initials: PA
authors.lastname: Levine
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Medina dos Santos
authors.forename: Sultan
authors.initials: S
authors.lastname: Pradhan
authors.forename: Victor
authors.initials: V
authors.lastname: Schramm
authors.forename: Carl
authors.initials: C
authors.lastname: Snyderman
authors.forename: William I
authors.initials: WI
authors.lastname: Wei
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D035262:Cranial Fossa, Anterior / Q000601:surgery*; D018572:Disease-Free Survival; D005147:Facial Bones / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate