What is the prognosis of head and neck mucosal melanomas?

Updated: May 07, 2020
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Melanoma of the mucosal membrane appears to have a lower prevalence of regional lymph node metastases than melanoma of the skin does, both at presentation and at recurrence. Lesions of the oral cavity have a higher prevalence than those occurring in either the nasal or the pharyngeal cavities. Overall, 18% of patients have lymphatic metastases at presentation. The average distant metastatic rate at presentation is 10%. Primary site recurrence occurs in approximately 40% of nasal cavity lesions, 25% of oral cavity lesions, and 32% of pharyngeal tumors. Overall primary site recurrence ranges from 55% to 66% and 16% to 35% for nodal recurrence. Most recurrences occur within the first 3 years. [21]

A study by Heppt et al of 444 individuals with mucosal melanoma, including of the head and neck, female genital tract, and anorectal region, found that 32.4% of patients had local relapses, with these occurring most commonly in cases of head and neck tumors. [22]

The mucosal melanoma of the oral cavity is very aggressive, and the absence of any standardized treatment protocol makes its prognosis unfortunate. The difficulties to obtain free surgical margins, the elevated tendency to invade in depth, and the early hematogenous metastasis have been referred as features that may explain its bad prognosis. As such, the prognosis for mucosal melanoma is generally quite poor, with a 3-year mortality rate higher than 50%.

A retrospective study by Dréno et al indicated that owing to its high potential for metastasis, sinonasal mucosal melanoma has a poor prognosis. The report, which included 44 patients, 25% of whom had an initial tumor classification of T4, found the cumulative overall survival rates at 1 and 5 years to be 71.5% and 33%, respectively. [23]

Negative surgical margins and the size of the primary lesion in head and neck mucosal melanoma do not appear to be predictive of outcome. Five-year survival rates range from 15-30%, with a median survival time of 25 months. Gingival melanoma has a slightly greater 5-year survival rate (18%) than that of palatal melanoma (11%), with a longer median survival time (46 mo vs 22 mo).

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