title: Mucosal melanoma of the head and neck: 32-year experience in a tertiary referral hospital.
abstract: BACKGROUND
  Primary mucosal melanomas of the head and neck (HNMM), albeit being rare, are rapidly lethal. Here we report the experience of patients with HNMM treated in our institution over a 32-year period.
  
  
  OBJECTIVE
  We aim to review our experience in managing HNMM patients over a 32-year period.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Thirty-five patients diagnosed with HNMM from 1978 to 2009 were retrospectively reviewed, with an emphasis on predictors on survival outcome.
  
  
  RESULTS
  Twenty-four patients received curative resection, 6 of them followed by adjuvant radiotherapy. Neck dissections were performed in 8 patients. Four patients received radiotherapy as primary treatment. Seven patients were treated conservatively. The overall mean and median survivals were 50 and 26 months, respectively. The median survival of stage I, II, and III diseases in our group of patients were 39, 10, and 16 months, respectively. The 1-year and 5-year overall survival rates were 65.7% and 22.9%, respectively. Age above 60 (p = 0.007), nodal involvement (p = 0.047;) and stage at presentation (p = 0.046) were shown to be associated with worse overall survival. Sites of tumour did not seem to impact on survival. On multivariate analysis, only age (below or above 60) was found to be statistically significant [RR 4.79 (1.65-13.9), p = 0.004].
  
  
  CONCLUSIONS
  Oral cavity melanomas are more likely to have nodal involvement at presentation. Prognosis of HNMM remains grave. Current evidence still supports surgery as the best chance of cure. Role of adjuvant radiotherapy is controversial and does not appear to improve overall survival. Similarly, role of neck dissection is ill-defined.
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong. richieclchan@gmail.com
authors.forename: Richie Chiu-Lung
authors.initials: RC
authors.lastname: Chan
authors.forename: Jimmy Yu Wai
authors.initials: JY
authors.lastname: Chan
authors.forename: William Ignace
authors.initials: WI
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D013997:Time Factors