The Prognostic Role of the Surgical Approach and Adjuvant Therapy in Operable Mucosal Melanoma of the Head and Neck
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Objectives. The aim of this study was to investigate the prognostic impact of the surgical approach and adjuvant treatment in operable malignant melanoma of head and neck (MMHN). Methods. Retrospective reviews of 31 patients who underwent surgery-based treatment with curative intent, either by the endoscopic or external approach, for MMHN were performed to analyze recurrence patterns, salvage modalities, and oncological outcomes (disease-specific survival and disease-free survival). Results. Overall recurrence rate was 61% (19/31). In stage III patients (n=24), 50% (12/24) developed recurrences with a median recurrence-free period of 6.0 months, and 30% (4/12) of them was successfully salvaged by reoperation with adjuvant radiotherapy. On the contrary, all stage IVA patients (n=7) developed recurrences with a median recurrence-free period of 4.4 months. Distant metastasis was the most common pattern of failure and no patients were salvaged. Among variables, age and T classification, not the surgical approach, were significant prognosticators for disease-free survival and disease-specific survival. Adjuvant radiotherapy was associated with a lower rate of local failure, compared to surgery alone (hazard ratio, 0.02; 95% confidence interval, 0.06 to 0.75; P=0.02). However, adjuvant systemic therapy was not effective in reducing the risk of failures for any pattern. Conclusion. Our data suggested that meticulous surgical resection, either by the endoscopic or external approach, with adjuvant radiotherapy increases the local control rate in MMHN.
Abstract
Objectives. The aim of this study was to investigate the prognostic impact of the surgical approach and adjuvant treatment in operable malignant melanoma of head and neck (MMHN). Methods. Retrospective reviews of 31 patients who underwent surgery-based treatment with curative intent, either by the endoscopic or external approach, for MMHN were performed to analyze recurrence patterns, salvage modalities, and oncological outcomes (disease-specific survival and disease-free survival). Results. Overall recurrence rate was 61% (19/31). In stage III patients (n=24), 50% (12/24) developed recurrences with a median recurrence-free period of 6.0 months, and 30% (4/12) of them was successfully salvaged by reoperation with adjuvant radiotherapy. On the contrary, all stage IVA patients (n=7) developed recurrences with a median recurrence-free period of 4.4 months. Distant metastasis was the most common pattern of failure and no patients were salvaged. Among variables, age and T classification, not the surgical approach, were significant prognosticators for disease-free survival and disease-specific survival. Adjuvant radiotherapy was associated with a lower rate of local failure, compared to surgery alone (hazard ratio, 0.02; 95% confidence interval, 0.06 to 0.75; P=0.02). However, adjuvant systemic therapy was not effective in reducing the risk of failures for any pattern. Conclusion. Our data suggested that meticulous surgical resection, either by the endoscopic or external approach, with adjuvant radiotherapy increases the local control rate in MMHN.
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