[Malignant rhino- and otobasal mucosal melanomas--therapy and outcome].
BACKGROUND
Malignant melanoma of the rhinobasal mucosa is very rare and makes up less than one percent of all malignant melanomas. Symptoms are unspecific in most cases, and patients often present with large tumours. During the past two decades, a variety of therapeutic modalities has been proposed.


METHODS
In a retrospective quality assessment, we analysed the charts of fifteen consecutive patients suffering from malignant melanoma of the skull base who where treated in our department since 1993. The influence of specific surgical and adjuvant therapy on recurrence and outcome was evaluated.


RESULTS
Initial symptoms were unspecific in all patients. Thus, melanoma was an accidental finding of a biopsy or sinus surgery in most patients, including all cases with amelanotic melanoma. All patients underwent surgery as the initial treatment, in 8 cases followed by adjuvant therapy. In these patients the disease specific survival was slightly better than in patients treated with surgery only. When recurrence was treated by radical mutilating surgery, this did not influence the overall prognosis.


CONCLUSIONS
We conclude from our data and analysis of literature that the prognosis of MM has not developed favourably during the past two decades. Radiation therapy and adjuvant immuno- or chemotherapy seems to have a positive impact. Mutilating surgery is usually not indicated nor is it associated with an improvement of outcome.
Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstrasse 5, Freiburg. arndt@hno.ukl.uni-freiburg.de
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Arndt
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Echternach
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Aschendorff
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Schipper
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Maier
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017233:Orbit Evisceration; D010157:Palatal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D010166:Palliative Care; D010255:Paranasal Sinus Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016019:Survival Analysis
D016898:Interferon-alpha