title: Survival Outcomes of Mucosal Melanoma in the Head and Neck: Case Series and Review of Current Treatment Guidelines.
abstract: OBJECTIVE
  Malignant mucosal melanoma of the head and neck (MMHN) is an aggressive and rare neoplasm with poor long-term outcomes. The aim of this study is to evaluate the outcomes of patients treated by a single-institution head and neck multidisciplinary team.
  
  
  METHODS
  In this retrospective case series, all MMHN cases treated at the Royal Melbourne Hospital from 1990-2015 were retrospectively reviewed. Patient demographic characteristics (eg, age), treatment offered, pathology, and outcomes were collected, tabulated, and correlated with outcomes. Survival outcomes were calculated by the Kaplan-Meier method. Comparison was made between oral and sinonasal melanomas.
  
  
  RESULTS
  A total of 16 cases were identified. Two were excluded because of inaccessible data. Of the 14 remaining cases, 8 were sinonasal melanomas and 6 were oral cavity melanomas. Sinonasal tumor patients presented with epistaxis or visual impairment. Oral melanoma patients presented with pigmented lesions or ulceration. Follow-up ranged from 4 months to 11 years. In 2 patients, locoregional recurrences developed that were successfully re-excised. Six patients died of distant metastases despite clear surgical margins. Two patients with sinonasal melanomas died of extensive local disease with intracranial invasion. One patient died 4 years after diagnosis without disease. There were no failures in the neck. The 2- and 5-year overall survival rates were 63.3% and 31.7%, respectively, by the Kaplan-Meier method. The difference in survival between oral and sinonasal melanomas was not statistically significant.
  
  
  CONCLUSIONS
  Despite clear surgical margins, MMHN has a poor prognosis and most deaths are due to distant metastases. Systemic therapies such as those used in cutaneous melanoma treatment might be used in the future for MMHN.
authors.affiliation: Registrar, Department of Oral and Maxillofacial Surgery, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia. Electronic address: Omar.breik@gmail.com.
authors.forename: Omar
authors.initials: O
authors.lastname: Breik
authors.affiliation: Head and Neck Fellow, Head and Neck Tumour Stream, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Felix
authors.initials: F
authors.lastname: Sim
authors.affiliation: Consultant Oral and Maxillofacial Surgeon, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Wong
authors.affiliation: Head of Unit, Department of Oral and Maxillofacial Surgery, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Alf
authors.initials: A
authors.lastname: Nastri
authors.affiliation: Head of Unit, Department of Otorhinolaryngology, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Iseli
authors.affiliation: Head, Head and Neck Tumour Stream, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Wiesenfeld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology*; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009297:Nasal Mucosa / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009669:Nose Neoplasms / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015996:Survival Rate