gms | German Medical Science

81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

12.05. - 16.05.2010, Wiesbaden

Malignant mucosal melanoma of the skull base and nasal cavity: 2 case reports

Meeting Abstract

  • corresponding author Patricia Trümper - Städt. Kliniken, HNO-Klinik, Kassel, Germany
  • presenting/speaker Ellen Kostka - Städt. Kliniken, HNO-Klinik, Kassel, Germany
  • presenting/speaker Vasileios Bezas - Städt. Kliniken, HNO-Klinik, Kassel, Germany
  • presenting/speaker Ulrike Bockmühl - Städt. Kliniken, HNO-Klinik, Kassel, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Wiesbaden, 12.-16.05.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10hno101

DOI: 10.3205/10hno101, URN: urn:nbn:de:0183-10hno1011

Published: July 6, 2010

© 2010 Trümper et al.
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Outline

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Introduction: Malignant melanoma of the nasal mucosa are very rare, they represent approximately 1% of malignancies of this region. The prognosis is very unfavorable, the 5-year survival rate is approximately 20%. The effectiveness of adjuvant treatment modalities such as interferon, chemotherapy and radiotherapy is always discussed controversially.

Methods: We report 2 patients with mucosal malignant melanoma at the anterior skull base (A) and the inferior turbinate (B). In the latter histology of inferior turbinate showed an amelanotic melanoma. This patient had no primary symptoms, while the patient with the frontal skull base tumor referred recurrent nasal bleeding.

Results: Classification of the melanomas was pT4 (A) and pT1 (B). In both cases an endonasal microendoscopic tumor resection was carried out with medial maxillectomy (B) and resection of the anterior skull base (A), respectively. Histologically both were R0-resections. Therefore an adjuvant therapy was not decided. Both patients developed recurrences after 6 (A) and 3 months (B), respectively. In case (A) the tumor showed intracerebral invasion and in case (B) the tumor infiltrated the retromaxillary space, the orbit and the anterior skull base as well as showed multilocular distant metastases. Interdisciplinary we performed re-resections, in case (A) as curative approach but in case (B) in palliative manner without orbital exenteration. Additionally, fractionated local radio-chemotherapy up to 60 Gy with cisplatin once weekly was concluded. A monotherapy with dacarbazine every 3–4 weeks followed. Patient (A) died after the second operation according to intracerebral bleeding and patient (B) showed local and distant tumor progression.

Conclusion: Radical primary surgical therapy is the therapy of first choice in malignant mucosal melanoma. Because of poor prognosis and difficult localization of these tumors, a mutilating surgery should be avoided in order to preserve the quality of life. Since the incidence of mucosal melanomas is low there exists still no evidence-based multimodal therapy concept which should stimulate a prospective interdisciplinary study.