Which factors are prognostic indicators in 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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Answer

According to a study at Memorial Sloan-Kettering Cancer Center, clinical stage at presentation, tumor thickness greater than 5mm, vascular invasion on histologic studies, and development of distant failure are the only independent predictors of outcome of mucosal melanoma of the head and neck. [24]

A retrospective study by Song et al of 82 patients with oral mucosal melanoma indicated that cell type, ulceration, mitotic rate, pigmentation, necrosis, and vascular invasion are prognostic factors for overall survival, with multivariate analysis revealing cell type to be an independent risk factor (although not in cases of localized disease). In addition, cell type, mitotic rate, and the presence of tumor-infiltrating lymphocytes were reported to be risk factors for distant metastasis, with tumor-infiltrating lymphocytes cited as an independent risk factor. [25]

The aforementioned study by Dréno et al reported that clinical risk factors for poor prognosis in sinonasal mucosal melanoma include headache, facial pain, and trigeminal V2 nerve anesthesia, while nasal involvement alone, without sinus involvement, indicates a greater likelihood of survival. [23]

Histologic predictors of survival in patients with localized, lymph node-negative (stage I, N0M0) primary mucosal melanomas of the head and neck show that microstaging according to invasion into the following 3 tissue compartments are found to be a significant and independent predictor of poor survival in such patients:

  • Level 1 – Melanoma in situ

  • Level 2 – Invasion in the lamina propria only

  • Level 3 – Invasion into deep tissue

The presence of sarcomatoid and pseudopapillary architecture and undifferentiated cells also appear to be associated with significantly poor disease-specific survival (DSS). Nodal involvement reduces median survival time to 18 months. Multiple local recurrences are the most common cause of treatment failure. Because of the natural history of this disease, however, 5-year survival rate data are of limited use, because the patient is constantly at risk of death from local recurrence and melanomatosis.


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