Abstract: Sinonasal mucosal melanoma (SNMM) is a rare tumor, comprising less than 10% of sinonasal malignancies. SNMM most frequently occurs in the nasal cavity (70%) and maxillary sinus (14%), typically as black patches. Overall, SNMM harbors a very poor prognosis; 5-year survival is less than 30%. Nasal cavity tumors confer a better prognosis than sinus melanoma. The primary management for SNMM is surgery, when feasible, followed by adjuvant radiotherapy. Recent studies suggest that immunotherapy may confer survival benefit to patients with advanced disease. The multidisciplinary team approach has been shown to optimize treatment, reduce costs, and minimize adverse events, while maximizing the chances for cure.
Keywords: mucosal melanoma, head and neck, multidisciplinary
Sinonasal mucosal melanoma (SNMM) is a rare tumor, comprising about 1% of all melanomas and about 4–8% of sinonasal malignancies.1,2 In recent years, SNMM has been considered and managed as a separate disease from cutaneous melanoma, including its staging system and treatment modalities.3
SNMM most commonly affects the nasal cavity (70%) and maxillary sinus (14%). Patients with nasal cavity origin have been shown to have a better prognosis than those with paranasal sinus tumors.4 The reported 5-year survival rate of SNMM is less than 30%.3,5
Treatment of early SNMM has traditionally been surgical, followed by adjuvant radiotherapy.3 A role for biologic treatment, as well as immunotherapy, has emerged over the last decade. However, SNMM is characterized by high variability in tumor characteristics, poor prognosis, complexity of treatment, and a vast range of new therapeutic targets. Hence, a single physician cannot manage all the aspects of treatment with state-of-the-art approaches. Rather, a multidisciplinary team (MDT) approach is mandatory for planning the best treatment modality and follow the disease course.
In this review paper, we present the latest updates on SNMM treatment, with an emphasis on the MDT approach.
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