Sinonasal Melanoma: A Single Institutional Analysis and Future Directions

Taylor Manton, Brittny Tillman, Jonathan McHugh, Emily Bellile, Scott McLean, Erin McKean

Research output: Contribution to journalArticle

Abstract

Background Sinonasal melanoma is a rare disease with a high mortality rate. The surgical management paradigm has significantly changed over the past decade with the introduction of expanded endonasal techniques. There have also been advances in management of metastatic and locally advanced disease with the advent of immunotherapy. Methods Single-institution retrospective review of adult patients with sinonasal melanoma, surgically managed at the University of Michigan over a 9-year period. Thirty-one patients met inclusion criteria. All patients were retrospectively staged according to the 7th Edition AJCC staging system for mucosal melanoma. Parameters that may affect survival were analyzed using Cox's proportional hazard models and survival outcomes were analyzed with the Kaplan-Meier method. Additionally, a review of three patients with distant metastatic disease receiving immunotherapy is presented. Results Most patients were managed endoscopically (67%), and had stage III disease (71%). However, 57% of stage IVB tumors were successfully managed endoscopically. Stage statistically impacted overall survival whereas distant control was impacted by stage, site of origin, mitotic rate, and necrosis. The 2-year overall survival for all stages was 77% which declined with advanced disease. Two-year locoregional control and distant control showed similar trends. Conclusion Treatment of sinonasal melanoma has drastically changed over the past decade with increased use of expanded endonasal techniques. Our review revealed excellent 2-year overall survival in stage III disease with an appreciable decline in survival in more advanced disease. Immunotherapy may play a large role is future management given the high-risk of distant metastasis.

Original languageEnglish (US)
Pages (from-to)484-492
Number of pages9
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume80
Issue number5
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Melanoma
Survival
Immunotherapy
Rare Diseases
Proportional Hazards Models
Direction compound
Necrosis
Neoplasm Metastasis
Mortality
Neoplasms
Therapeutics

Keywords

  • expanded endonasal technique
  • immunotherapy
  • mucosal melanoma
  • outcomes
  • sinonasal malignancy

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Sinonasal Melanoma : A Single Institutional Analysis and Future Directions. / Manton, Taylor; Tillman, Brittny; McHugh, Jonathan; Bellile, Emily; McLean, Scott; McKean, Erin.

In: Journal of Neurological Surgery, Part B: Skull Base, Vol. 80, No. 5, 01.01.2019, p. 484-492.

Research output: Contribution to journalArticle

Manton, Taylor ; Tillman, Brittny ; McHugh, Jonathan ; Bellile, Emily ; McLean, Scott ; McKean, Erin. / Sinonasal Melanoma : A Single Institutional Analysis and Future Directions. In: Journal of Neurological Surgery, Part B: Skull Base. 2019 ; Vol. 80, No. 5. pp. 484-492.
@article{18f794ba4bfb4fb08f4e20445312e213,
title = "Sinonasal Melanoma: A Single Institutional Analysis and Future Directions",
abstract = "Background Sinonasal melanoma is a rare disease with a high mortality rate. The surgical management paradigm has significantly changed over the past decade with the introduction of expanded endonasal techniques. There have also been advances in management of metastatic and locally advanced disease with the advent of immunotherapy. Methods Single-institution retrospective review of adult patients with sinonasal melanoma, surgically managed at the University of Michigan over a 9-year period. Thirty-one patients met inclusion criteria. All patients were retrospectively staged according to the 7th Edition AJCC staging system for mucosal melanoma. Parameters that may affect survival were analyzed using Cox's proportional hazard models and survival outcomes were analyzed with the Kaplan-Meier method. Additionally, a review of three patients with distant metastatic disease receiving immunotherapy is presented. Results Most patients were managed endoscopically (67{\%}), and had stage III disease (71{\%}). However, 57{\%} of stage IVB tumors were successfully managed endoscopically. Stage statistically impacted overall survival whereas distant control was impacted by stage, site of origin, mitotic rate, and necrosis. The 2-year overall survival for all stages was 77{\%} which declined with advanced disease. Two-year locoregional control and distant control showed similar trends. Conclusion Treatment of sinonasal melanoma has drastically changed over the past decade with increased use of expanded endonasal techniques. Our review revealed excellent 2-year overall survival in stage III disease with an appreciable decline in survival in more advanced disease. Immunotherapy may play a large role is future management given the high-risk of distant metastasis.",
keywords = "expanded endonasal technique, immunotherapy, mucosal melanoma, outcomes, sinonasal malignancy",
author = "Taylor Manton and Brittny Tillman and Jonathan McHugh and Emily Bellile and Scott McLean and Erin McKean",
year = "2019",
month = "1",
day = "1",
doi = "10.1055/s-0038-1676355",
language = "English (US)",
volume = "80",
pages = "484--492",
journal = "Journal of Neurological Surgery, Part B: Skull Base",
issn = "2193-6331",
publisher = "Thieme Medical Publishers",
number = "5",

}

TY - JOUR

T1 - Sinonasal Melanoma

T2 - A Single Institutional Analysis and Future Directions

AU - Manton, Taylor

AU - Tillman, Brittny

AU - McHugh, Jonathan

AU - Bellile, Emily

AU - McLean, Scott

AU - McKean, Erin

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background Sinonasal melanoma is a rare disease with a high mortality rate. The surgical management paradigm has significantly changed over the past decade with the introduction of expanded endonasal techniques. There have also been advances in management of metastatic and locally advanced disease with the advent of immunotherapy. Methods Single-institution retrospective review of adult patients with sinonasal melanoma, surgically managed at the University of Michigan over a 9-year period. Thirty-one patients met inclusion criteria. All patients were retrospectively staged according to the 7th Edition AJCC staging system for mucosal melanoma. Parameters that may affect survival were analyzed using Cox's proportional hazard models and survival outcomes were analyzed with the Kaplan-Meier method. Additionally, a review of three patients with distant metastatic disease receiving immunotherapy is presented. Results Most patients were managed endoscopically (67%), and had stage III disease (71%). However, 57% of stage IVB tumors were successfully managed endoscopically. Stage statistically impacted overall survival whereas distant control was impacted by stage, site of origin, mitotic rate, and necrosis. The 2-year overall survival for all stages was 77% which declined with advanced disease. Two-year locoregional control and distant control showed similar trends. Conclusion Treatment of sinonasal melanoma has drastically changed over the past decade with increased use of expanded endonasal techniques. Our review revealed excellent 2-year overall survival in stage III disease with an appreciable decline in survival in more advanced disease. Immunotherapy may play a large role is future management given the high-risk of distant metastasis.

AB - Background Sinonasal melanoma is a rare disease with a high mortality rate. The surgical management paradigm has significantly changed over the past decade with the introduction of expanded endonasal techniques. There have also been advances in management of metastatic and locally advanced disease with the advent of immunotherapy. Methods Single-institution retrospective review of adult patients with sinonasal melanoma, surgically managed at the University of Michigan over a 9-year period. Thirty-one patients met inclusion criteria. All patients were retrospectively staged according to the 7th Edition AJCC staging system for mucosal melanoma. Parameters that may affect survival were analyzed using Cox's proportional hazard models and survival outcomes were analyzed with the Kaplan-Meier method. Additionally, a review of three patients with distant metastatic disease receiving immunotherapy is presented. Results Most patients were managed endoscopically (67%), and had stage III disease (71%). However, 57% of stage IVB tumors were successfully managed endoscopically. Stage statistically impacted overall survival whereas distant control was impacted by stage, site of origin, mitotic rate, and necrosis. The 2-year overall survival for all stages was 77% which declined with advanced disease. Two-year locoregional control and distant control showed similar trends. Conclusion Treatment of sinonasal melanoma has drastically changed over the past decade with increased use of expanded endonasal techniques. Our review revealed excellent 2-year overall survival in stage III disease with an appreciable decline in survival in more advanced disease. Immunotherapy may play a large role is future management given the high-risk of distant metastasis.

KW - expanded endonasal technique

KW - immunotherapy

KW - mucosal melanoma

KW - outcomes

KW - sinonasal malignancy

UR - http://www.scopus.com/inward/record.url?scp=85072544924&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072544924&partnerID=8YFLogxK

U2 - 10.1055/s-0038-1676355

DO - 10.1055/s-0038-1676355

M3 - Article

C2 - 31534890

AN - SCOPUS:85072544924

VL - 80

SP - 484

EP - 492

JO - Journal of Neurological Surgery, Part B: Skull Base

JF - Journal of Neurological Surgery, Part B: Skull Base

SN - 2193-6331

IS - 5

ER -