title: Optimal multidisciplinary treatment of oral cavity mucosal melanoma: outcome analysis in a case series.
abstract: Oral cavity mucosal melanomas (OCMM) represent only 3% of all malignant melanomas. Surgery is the mainstay of treatments and it is often followed by adjuvant radiotherapy. The role of adjuvant immunotherapy and/or chemotherapy is still debated and to date neither treatment is routinely used. From January 1990 to January 2010, we have collected from our database data of 20 patients with a histologically proven diagnosis of OCMM. Upfront surgery, followed by adjuvant radiotherapy was performed in 16/20 (80%) patients. Immunohistochemical analysis was carried out on all tissue samples and the following markers were assessed: Ki-67, HMG-45, Melan-A, S-100, CD31, CD35, CD20, CD21, and CD3. Although Ki-67, HMG-45, Melan-A, and S-100 were assessed in tumor cells, the analysis of CD31, CD21, CD20, CD3, and CD35 was carried out on the tumor-infiltrating lymphocytes. Patient outcome was analyzed and associated with clinical and Immunohistochemical tumor characteristics. The median overall survival (OS) was 12 months, with a 2-year OS rate of 30%. The median progression-free survival (PFS) was 9 months, with a 2-year PFS rate of 25%. Grade of lymphocyte infiltration (CD20 and CD3 expression) correlated strongly with prognosis. Interestingly, overexpression of CD21 along with downregulation of CD31 was significantly associated with better OS and PFS, whereas the reversal features correlated with a poor prognosis. Our report shows that patients affected by OCMM have a poor prognosis despite the administration of multimodal treatments. Moreover, our analysis suggests that the evaluation of several biomarkers, especially in tumor-infiltrating lymphocytes, may identify categories of patients with distinct immune response against the tumor and possibly different treatment response and prognosis.
authors.affiliation: aMedical Oncology Unit, POC SS Annunziata, Taranto bDepartment of Otolaryngology, Otolaryngology and Maxillo-Facial Unit cDepartment of Pathology, Dermatology Unit dDepartment of Dermatology, Pathology Unit, University of Bari, Bari eDepartment of Biostructures and Bioimages, University of Naples 'Federico II' fDepartment of Clinical Medicine and Surgery, University Federico II gOtolaryngology Unit, National Tumour Institute of Naples 'Foundation G. Pascale', Naples, Italy hLester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perri
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pisconti
authors.forename: Matteo
authors.initials: M
authors.lastname: Favia
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Della Vittoria Scarpati
authors.forename: Manuel
authors.initials: M
authors.lastname: Conson
authors.forename: Mario
authors.initials: M
authors.lastname: Giuliano
authors.forename: Franco
authors.initials: F
authors.lastname: Ionna
authors.forename: Francesco
authors.initials: F
authors.lastname: Longo
authors.forename: Bonamonte
authors.initials: B
authors.lastname: Domenico
authors.forename: Eugenio
authors.initials: E
authors.lastname: Maiorano
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Favia
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008875:Middle Aged; D009061:Mouth Mucosa / Q000378:metabolism / Q000473:pathology*; D009062:Mouth Neoplasms / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant
chemical_list: D014408:Biomarkers, Tumor