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Şendişçi Gök R, Tercanlı H. A ten-year literature review of oral malignant melanoma cases: A meta-analysis study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101922. [PMID: 38795910 DOI: 10.1016/j.jormas.2024.101922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
AIM Oral malignant melanoma (OMM) is a rare and aggressive malignant tumour arising from the proliferation of melanocytes and accounts for only 0.5 % of all oral malignancies. It is invasive and tends to metastasise. The aim of this study is to determine the patient profile of OMM and to provide information about the clinical features and treatment plans of the disease. MATERIALS AND METHODS The Pubmed database was searched for OMM cases published as case reports in the last 10 years. The search was limited to English and open-access case reports. A total of 49 OMMs in 45 patients from 43 case reports were analyzed. In addition to the age, gender, smoking and alcohol consumption habits of the patients, data on the signs and symptoms of OMM, location of the lesion, imaging modalities used in diagnosis and treatment, lymph node involvement, presence of metastasis, survival time, and treatment modalities were recorded. RESULTS In OMM cases, 18 (40 %) of the patients were female, 27 (60 %) were male, and the mean age was 53.13 ± 16.09 years. The most common symptom was "swelling" (n = 23, 33.8 %) and the most common finding was "hyperpigmentation" (n = 40, 24.4 %). The most common site of OMM was the maxilla (n = 21, 46.7 %). According to the rate of use of imaging modalities in the cases, it was determined that "advanced imaging modalities" were mostly used (n = 24, 53.3 %). It was determined that 22.2 % (n = 10) of the patients died within the first 5 years. Combined treatment (n = 21, 46.5 %) were mostly applied to the patients. CONCLUSION OMM is more common in the maxilla, in males and in the fifth decade of life, and advanced imaging modalities are most commonly used to detect the disease. Because of its poor prognosis, knowing the patient profile and common clinical features of OMM will increase the clinical awareness of physicians.
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Affiliation(s)
- Rümeysa Şendişçi Gök
- Research asistant, Akdeniz University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Antalya, Turkey.
| | - Hümeyra Tercanlı
- Associate professor, Akdeniz University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Antalya, Turkey
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Correia-Neto IJ, Correa MB, Araújo ALD, Penafort PVM, Colafemina ACE, Elias RDA, Santos-Silva AR, Vargas PA, Lopes MA. A primary oral mucosal melanoma of the hard palate with no recurrence: Report of a 10 years follow-up. SPECIAL CARE IN DENTISTRY 2024; 44:751-755. [PMID: 37814400 DOI: 10.1111/scd.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Primary oral mucosal melanoma (OMM) represents an extremely rare and aggressive tumor that arises from malignant transformation and clonal expansion of melanocytes in the oral cavity. The prognosis of patients affected by OMM is quite unfavorable, with survival rates lower than those described for patients with cutaneous melanoma. CASE REPORT Here, we report a case of OMM in a 59-year-old Caucasian woman, who was referred for evaluation of a large asymptomatic pigmented lesion on the left side of the hard palate under the removable total denture. Incisional biopsy was performed, and histopathological analysis revealed the proliferation of spindle-shaped and pigmented epithelioid cells, with cellular pleomorphism. These cells were positive for Melan A, S-100, HMB-45, SOX-10, and Ki-67 confirming the diagnosis of OMM. The patient underwent partial maxillectomy and adjuvant radiotherapy. After treatment, she was rehabilitated with a palatal obturator prosthesis and has been in follow-up for 10 years with no evidence of disease. Due to the rarity in the oral cavity and the nonspecific signs and symptoms, the diagnosis of OMM is difficult and often overlooked. CONCLUSION Therefore, multidisciplinary management from diagnosis, treatment, and rehabilitation is important to increase the expectation of cure.
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Affiliation(s)
- Ivan José Correia-Neto
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Marcelo Brum Correa
- Head and neck surgeon, Private office, Piracicaba, Sâo Paulo, Brazil, Piracicaba, Brazil
| | - Anna Luíza Damaceno Araújo
- Head and Neck Surgery Department, University of São Paulo Medical School (UFMUSP), São Paulo, São Paulo, Brazil
| | - Paulo Victor Mendes Penafort
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Rogério de Andrade Elias
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Vieira GDS, Kimura TDC, Scarini JF, de Lima-Souza RA, Lavareze L, Emerick C, Gonçalves MT, Damas II, Figueiredo-Maciel T, Sales de Sá R, Aquino IG, Gonçalves de Paiva JP, Fernandes PM, Gonçalves MWA, Kowalski LP, Altemani A, Fillmore GC, Mariano FV, Egal ESA. Hematopoietic colony-stimulating factors in head and neck cancers: Recent advances and therapeutic challenges. Cytokine 2024; 173:156417. [PMID: 37944421 DOI: 10.1016/j.cyto.2023.156417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
Colony-stimulating factors (CSFs) are key cytokines responsible for the production, maturation, and mobilization of the granulocytic and macrophage lineages from the bone marrow, which have been gaining attention for playing pro- and/or anti-tumorigenic roles in cancer. Head and neck cancers (HNCs) represent a group of heterogeneous neoplasms with high morbidity and mortality worldwide. Treatment for HNCs is still limited even with the advancements in cancer immunotherapy. Novel treatments for patients with recurrent and metastatic HNCs are urgently needed. This article provides an in-depth review of the role of hematopoietic cytokines such as granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), macrophage colony-stimulating factor (M-CSF), and interleukin-3 (IL-3; also known as multi-CSF) in the HNCs tumor microenvironment. We have reviewed current results from clinical trials using CSFs as adjuvant therapy to treat HNCs patients, and also clinical findings reported to date on the therapeutic application of CSFs toxicities arising from chemoradiotherapy.
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Affiliation(s)
- Gustavo de Souza Vieira
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Talita de Carvalho Kimura
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - João Figueira Scarini
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Reydson Alcides de Lima-Souza
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Luccas Lavareze
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carolina Emerick
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Mayara Trevizol Gonçalves
- Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Ingrid Iara Damas
- Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Tayná Figueiredo-Maciel
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Raisa Sales de Sá
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Iara Gonçalves Aquino
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - João Paulo Gonçalves de Paiva
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Patrícia Maria Fernandes
- Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Moisés Willian Aparecido Gonçalves
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, School of Medicine, University of São Paulo (USP), São Paulo, Brazil; Department of Head and Neck Surgery and Otolaryngology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Albina Altemani
- Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Gary Chris Fillmore
- Biorepository and Molecular Pathology, Huntsman Cancer Institute, University of Utah (UU), Salt Lake City, UT, United States
| | - Fernanda Viviane Mariano
- Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Erika Said Abu Egal
- Department of Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; Biorepository and Molecular Pathology, Huntsman Cancer Institute, University of Utah (UU), Salt Lake City, UT, United States.
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Tamura K, Kumabe Y, Kishimoto Y, Kitamura M, Mizuta M, Tamaki H, Honda K, Yamada K, Tanaka S, Kojima T, Asato R, Ushiro K, Shinohara S, Takebayashi S, Maetani T, Ichimaru K, Kitani Y, Omori K. Mucosal melanoma of the head and neck: a retrospective analysis of 34 cases in Japan. Acta Otolaryngol 2024; 144:82-89. [PMID: 38362716 DOI: 10.1080/00016489.2024.2314590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Mucosal melanoma of the head and neck (MMHN) is a rare condition. This study aimed to investigate oncological outcomes of surgical intervention in patients with MMHN. MATERIALS AND METHODS The study included 34 patients with MMHN who underwent surgical resection as initial treatment at 10 institutions in Japan between July 2005 and June 2015. Results: The 5-year overall survival (OS), local control rate (LCR), disease-free survival (DFS), and disease-specific survival (DSS) rates were 48.7%, 53.4%, 32.4%, and 55.1%, respectively. Based on multivariate analysis, no independent prognostic factors for the 5-year OS and DSS were found. Based on univariate analysis, the 5-year LCR was worse in patients with lesions in the nasal cavity and paranasal sinuses than in the oral cavity and pharynx. However, no differences in oncological outcomes were identified in relation to primary sites, and postoperative radiotherapy (PORT) and adjuvant systemic therapy did not contribute to improvements in the 5-year OS. CONCLUSIONS No independent prognostic factors for the 5-year OS or DSS were identified. Regional or distant recurrences are often identified, regardless of local control with surgical resection. Difficult control of MMHN with conventional therapeutic strategies, such as surgical intervention, PORT, and systemic therapy, has been suggested.
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Affiliation(s)
- Keiichi Tamura
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Kumabe
- Department of Otolaryngology-Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Morimasa Kitamura
- Department of Head and Neck Surgery, Kanazawa Medical University, Ishikawa, Japan
| | | | - Hisanobu Tamaki
- Department of Otolaryngology-Head & Neck Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Keigo Honda
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichiro Yamada
- Department of Otolaryngology-Head & Neck Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Shinzo Tanaka
- Department of Otolaryngology-Head & Neck Surgery, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryo Asato
- Department of Otolaryngology-Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koji Ushiro
- Department of Otolaryngology-Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shogo Shinohara
- Department of Otolaryngology-Head & Neck Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Shinji Takebayashi
- Department of Otorhinolaryngology-Head & Neck Surgery, Shiga General Hospital, Shiga, Japan
| | - Toshiki Maetani
- Department of Otolaryngology-Head and Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kazuyuki Ichimaru
- Department of Otolaryngology-Head & Neck Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yoshiharu Kitani
- Department of Otorhinolaryngology-Head & Neck Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Akay S, Pollard JH, Saad Eddin A, Alatoum A, Kandemirli S, Gholamrezanezhad A, Menda Y, Graham MM, Shariftabrizi A. PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms. Cancers (Basel) 2023; 15:3759. [PMID: 37568575 PMCID: PMC10417627 DOI: 10.3390/cancers15153759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis of sinonasal malignancies and can also be used as a "metabolic biopsy" in the characterization of some of the more common subgroups of these tumors, though due to overlap in uptake, histological confirmation is still needed. For certain tumor types, radiotracers, such as 11C-choline, and radiolabeled somatostatin analogs, including 68Ga-DOTATATE/DOTATOC, have proven useful in treatment planning and surveillance. Although serial scans for posttreatment surveillance allow the detection of subclinical lesions, the optimal schedule and efficacy in terms of survival are yet to be determined. Pitfalls of 18F-FDG, such as post-surgical and post-radiotherapy crusting and inflammation, may cause false-positive hypermetabolism in the absence of relapse.
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Affiliation(s)
- Sinan Akay
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Janet H. Pollard
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Assim Saad Eddin
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Aiah Alatoum
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Sedat Kandemirli
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90030, USA
| | - Yusuf Menda
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Michael M. Graham
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ahmad Shariftabrizi
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Haimowitz S, Cohen DA, Dhanda A, Barron K, Povolotskiy R, Roden D. Mucosal Melanoma of the Oral Cavity: What is the Role of Elective Neck Dissection? Laryngoscope 2023; 133:317-326. [PMID: 35560997 PMCID: PMC10084066 DOI: 10.1002/lary.30152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Mucosal melanoma (MM) is a rare malignancy that can present in the head and neck (H&N). The Oral cavity is the second most common primary site in the H&N after sinonasal mucosa. This study investigates the impact of demographic and clinical factors on survival in oral cavity MM. Further, it investigates the outcomes and utility of elective neck dissections (END) in the management of oral MM. METHODS The National Cancer Database was used to evaluate 432 patients with oral cavity MM from 2004 to 2016. Kaplan-Meir and Cox regression analyses were used to determine variables associated with survival. RESULTS The mean age was 64.0 ± 16.0 years. Most patients were white (85.1%) and male (60.0%). Gingiva (37.6%) and hard palate (36.1%) were the most common primary subsites in the oral cavity. Five-year overall survival was 31.0%. Age (Hazards Ratio [95% Confidence Interval], 1.03 [1.01-1.06]), N-stage (1.94 [1.10-3.42]), M-stage (10.13 [3.33-30.86]), male sex (1.79 [1.06-3.03]), and African-American race (2.63 [1.14-6.11]) were significantly associated with worse survival. 199 patients (46.9%) underwent neck dissection including 118 with lymph node yield (LNY) ≥ 18. The rate of occult nodal positivity was 45.4% for LNY ≥ 18 and 28.3% for LNY ≥ 1. ENDs were not associated with improved outcomes. However, occult lymph node involvement was associated with worse overall survival (p = 0.004). CONCLUSIONS Oral cavity MM has a poor prognosis. Lymph node involvement, distant metastasis, age, race, and male sex are associated with worse outcomes. Performing an END did not improve survival. However, END may have a prognostic role and help select patients for treatment intensification. LEVEL OF EVIDENCE 4 Laryngoscope, 133:317-326, 2023.
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Affiliation(s)
- Sean Haimowitz
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - David A Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Aatin Dhanda
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Kendyl Barron
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Roman Povolotskiy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Dylan Roden
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Fernandez IJ, Spagnolo F, Roncadi L, Molinari G, Marchioni D, Presutti L, Lucidi D. Primary mucosal melanoma of the larynx: systematic review of the literature and qualitative synthesis. Eur Arch Otorhinolaryngol 2022; 279:5535-5545. [PMID: 35913632 DOI: 10.1007/s00405-022-07565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/19/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Primary mucosal melanoma of the larynx (PLM) is a rare entity among head and neck cancers. Due to its rarity, clear protocols of management are not available. A deeper knowledge of the clinical and biological behaviour of PLM is strongly needed. METHODS According to PRISMA process, we searched through electronic databases case reports, case series and review articles providing relevant clinical data. The survival analysis was performed with Kaplan-Meier survival curves, using disease free survival (DFS) and overall survival (OS) as endpoints. RESULTS 1074 articles were initially screened, of which 37 studies describing 44 PLM cases were selected and included in the analysis. Mean age was 59.7 years with a mean follow-up time of 25.4 months. The most common symptom at presentation was hoarseness (52%), while the most involved laryngeal subsite was supraglottic region (62%). Most patients presented with an advanced stage. Tumour (T) and node (N) status at presentation did not influence OS nor DFS, whereas distant metastases (M) status resulted significantly associated with the reduction of OS and DFS time (Mantel-Cox: p < 0.0001 and p = 0.001, respectively). The laryngeal subsite and the type of surgery performed did not significantly impact on OS and DFS. CONCLUSIONS Treatment for PLM remains debated. Surgery with safe margins is recommended due to the high rates of local recurrence. Systemic therapy is advised for metastatic disease. However, the prognosis remains poor even after radical resection or targeted therapy.
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Affiliation(s)
- Ignacio Javier Fernandez
- Otolaryngology Head and Neck Surgery Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Federico Spagnolo
- Otolaryngology Head and Neck Surgery Department, University of Modena and Reggio-Emilia, Policlinico di Modena, Via del Pozzo 71, 41124, Modena, Italy.
| | - Leonardo Roncadi
- Otolaryngology Head and Neck Surgery Department, University of Modena and Reggio-Emilia, Policlinico di Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Giulia Molinari
- Otolaryngology Head and Neck Surgery Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniele Marchioni
- Otolaryngology Head and Neck Surgery Department, University of Modena and Reggio-Emilia, Policlinico di Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Livio Presutti
- Otolaryngology Head and Neck Surgery Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniela Lucidi
- Otolaryngology Head and Neck Surgery Department, University of Modena and Reggio-Emilia, Policlinico di Modena, Via del Pozzo 71, 41124, Modena, Italy
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8
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Janardhan D, George NA, Suresh S, Patil S, Thomas S, Iype EM. Mucosal Melanomas of the Oral Cavity: A Tertiary Care Centre Experience of Surgically Treated Cases. Indian J Otolaryngol Head Neck Surg 2022; 74:2099-2103. [PMID: 36452545 PMCID: PMC9702047 DOI: 10.1007/s12070-020-01962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022] Open
Abstract
Mucosal melanoma of oral cavity (MMO) is a relatively rare tumour comprising of 40% of all head and neck mucosal melanomas. This study assessed the treatment outcomes and factors affecting prognosis in oral cavity mucosal melanomas. The clinical case records of 25 cases of oral cavity mucosal melanomas treated in our institution during 2003-2013 were retrospectively reviewed. Various clinicopathological parameters were taken into consideration and statistical analysis done by Kaplan-Meier method and Cox's proportional hazards model. The most common sites of MMO were upper alveolus and hard palate (64%) followed by lower alveolus (28%). 57.1% mucosal melanomas of hard palate and upper alveolus had associated metastatic lymph nodes whereas all cases of MMO of lower alveolus had lymph node metastasis. Disease failure at distant sites was higher than that at primary site or lymph nodes. The most common site of distant metastases was brain. The 5-year OS for treated cases was 23.8% and among subsites, MMO of hard palate and upper alveolus had the highest survival. Metastasis to lymph nodes and bone infiltration by tumour significantly decreased the survival. Recurrence at primary site had the worst prognosis. MMO with lymph nodal involvement and bone erosion had poor prognosis. Due to high chances of lymph node metastases and disease recurrence in lymph nodes following treatment, it is essential to do an elective neck dissection for all cases of MMO. Disease failure at primary site was an independent predictor of outcome in MMO.
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Affiliation(s)
- Deepak Janardhan
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - Nebu Abraham George
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - Sandeep Suresh
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - Shirish Patil
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - Shaji Thomas
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - Elizabeth Mathew Iype
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala India
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9
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Lian B, Si L, Chi ZH, Sheng XN, Kong Y, Wang X, Tian H, Li K, Mao LL, Bai X, Tang BX, Yan XQ, Li SM, Zhou L, Dai J, Tang XW, Ran FW, Yao S, Guo J, Cui CL. Toripalimab (anti-PD-1) versus High-Dose Interferon-α2b as Adjuvant Therapy in Resected Mucosal Melanoma: A Phase II Randomized Trial. Ann Oncol 2022; 33:1061-1070. [PMID: 35842199 DOI: 10.1016/j.annonc.2022.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND No standard of care for mucosal melanoma (MM) in the adjuvant setting has been established. Meanwhile, relapse-free survival (RFS) is only about five months after surgery alone. This phase II trial aimed to compare toripalimab vs. high-dose interferon-α2b (HDI) as an adjuvant therapy for resected MM. PATIENTS AND METHODS From July 2017 to May 2019, 145 patients with resected MM were randomized (1:1) to receive HDI (N = 72) or toripalimab (N = 73) for one year until disease relapse/distant metastasis, unacceptable toxicity, or withdrawal of consent. The primary endpoint was RFS. The secondary endpoints included distant metastasis-free survival (DMFS), overall survival (OS), and safety. RESULTS After a median follow-up of 26.3 months, the numbers of RFS, OS, and DMFS events were 51 vs. 46, 33 vs. 29, and 49 vs. 44 in the toripalimab arm and the HDI arm, respectively. The median RFS were 13.6 (95%CI: 8.31-19.02) months and 13.9 (95%CI: 8.28-19.61) months in the toripalimab arm and HDI arm, respectively. The DMFS was not significantly different between the two arms (HR: 1.00, 95%CI: 0.65-1.54). The median OS was 35.1 months (95%CI: 27.93-NR) in the toripalimab arm, with no significant difference in all-cause death (HR: 1.11, 95% CI: 0.66-1.84) for the two arms. The median sums of the patients' actual infusion doses were 3672 mg and 1054.5 MIU in the toripalimab arm and HDI arm, respectively. The incidence of treatment-emergent adverse events with a grade ≥ 3 was much higher in the HDI arm than in the toripalimab arm (87.5% vs. 27.4%). CONCLUSION Toripalimab showed a similar RFS and a more favorable safety profile than HDI, both better than historical data, suggesting that toripalimab might be the better treatment option. However, additional translational studies and better treatment regimens are still warranted to improve the clinical outcome of MM.
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Affiliation(s)
- B Lian
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - L Si
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Z H Chi
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - X N Sheng
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Y Kong
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - X Wang
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - H Tian
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - K Li
- Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, Kunming, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - L L Mao
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - X Bai
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - B X Tang
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - X Q Yan
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - S M Li
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - L Zhou
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - J Dai
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - X W Tang
- Shanghai Junshi Biosciences, Shanghai, China
| | - F W Ran
- Shanghai Junshi Biosciences, Shanghai, China
| | - S Yao
- Shanghai Junshi Biosciences, Shanghai, China
| | - J Guo
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - C L Cui
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
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10
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Bansal SP, Dhanawade SS, Arvandekar AS, Mehta V, Desai RS. Oral Amelanotic Melanoma: A Systematic Review of Case Reports and Case Series. Head Neck Pathol 2022; 16:513-524. [PMID: 34309791 PMCID: PMC9187796 DOI: 10.1007/s12105-021-01366-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022]
Abstract
Oral amelanotic melanoma (OAM) is a rare, non-pigmented mucosal neoplasm representing less than 2% of all melanoma. The present study analyses the available data on OAM and describes its clinicopathological features, identifying potential prognostic factors. Online electronic databases such as PubMed-Medline, Embase, and Scopus were searched using appropriate keywords from the earliest available date till 31st March 2021 without restriction on language. Additional sources like Google Scholar, major journals, unpublished studies, conference proceedings, and cross-references were explored. 37 publications were included for quantitative synthesis, comprising 55 cases. The mean age of the patients was 59.56 years, and the lesions were more prevalent in males than in females. OAM's were most prevalent in the maxilla (67.2%) with ulceration, pinkish-red color, nodular mass, and pain. 2 patients (3.36%) were alive at their last follow-up, and 25 were dead (45.4%). Univariate survival analysis of clinical variables revealed that age older than 68 years (p = 0.003), mandibular gingiva (p = 0.007), round cells (p = 0.004), and surgical excision along with chemotherapy & radiation therapy (p = 0.001) were significantly associated with a lower survival rate. Oral Amelanotic Melanoma is a neoplasm with a poor prognosis, presenting a 6.25% possibility of survival after 5 years. Patients older than 68 years, lesions in the mandibular gingiva, round cells, and surgical excision along with chemotherapy and radiotherapy, presented the worst prognosis. However, they did not represent independent prognostic determinants for these patients.
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Affiliation(s)
- Shivani P. Bansal
- Department of Oral Pathology, Nair Hospital Dental College, Dr. A.L Nair Road Mumbai Central, Mumbai, 400008 India
| | - Sonal Sunil Dhanawade
- Department of Oral Pathology, Nair Hospital Dental College, Dr. A.L Nair Road Mumbai Central, Mumbai, 400008 India
| | - Ankita Satish Arvandekar
- Department of Oral Pathology, Nair Hospital Dental College, Dr. A.L Nair Road Mumbai Central, Mumbai, 400008 India
| | - Vini Mehta
- Department of Public Health Dentistry, Peoples College of Dental Sciences & Research Center, Bhopal, Madhya Pradesh 462037 India
| | - Rajiv S. Desai
- Department of Oral Pathology, Nair Hospital Dental College, Dr. A.L Nair Road Mumbai Central, Mumbai, 400008 India
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11
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Xiao J, Su M, Wang D. Primary Malignant Melanoma of the Oropharynx Presented on 18F-FDG PET/CT. Clin Nucl Med 2021; 46:741-743. [PMID: 33630806 DOI: 10.1097/rlu.0000000000003554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Primary malignant melanoma in the oropharynx is extremely rare. A 49-year-old man presented with a 3-month history of progressive dysphagia. An outside CT scan of the head and neck showed a space-occupying lesion in the oropharynx. Staging with FDG PET/CT demonstrated a hypermetabolic mass in the right wall of the oropharynx. A biopsy revealed malignant melanoma. The patient underwent total resection of the tumor, with no recurrence after 6-month follow-up.
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Affiliation(s)
- JingXing Xiao
- From the Department of Nuclear Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
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12
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Abiri A, Yasaka TM, Lehrich BM, Goshtasbi K, Papagiannopoulos P, Tajudeen BA, St John MA, Harris JP, Kuan EC. Adjuvant Therapy and Prognosticators of Survival in Head and Neck Mucosal Melanoma. Laryngoscope 2021; 132:584-592. [PMID: 34355791 DOI: 10.1002/lary.29807] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify prognosticators and determine the efficacies of surgery with adjuvant radiotherapy (SR) and surgery with immunotherapy (SI) of head and neck mucosal melanoma (HNMM). STUDY DESIGN Retrospective database study. METHODS The 2004 to 2017 National Cancer Database was queried for HNMM patients. Cox proportional hazards and Kaplan-Meier analyses evaluated prognosticators of mortality and survival benefits conferred by SR, SI, or surgery with adjuvant radiotherapy and immunotherapy (SRI). Logistic regression identified predictors of adjuvant radiotherapy or immunotherapy use. RESULTS Overall, 1,910 cases (845 surgery, 802 SR, 51 SI, 101 SRI) were analyzed, with 50.3% females and an average age of 68.6 ± 13.8 years. SI was associated with greater overall survival (OS) than surgery (hazard ratio [HR] 0.672; P = .036). SI (HR 0.425; P = .024) and SRI (HR 0.594; P = .045) were associated with superior OS than SR. Older age (HR 1.607; P < .001), female sex (HR 0.757; P = .006), paranasal sinus localization (HR 1.648; P < .001), T4 classification (HR 1.443; P < .001), N1 classification (HR 2.310; P < .001), M1 classification (HR 3.357; P < .001), and positive surgical margins (HR 1.454; P < .001) were survival prognosticators. Adjuvant radiotherapy use was negatively correlated with older age, oral cavity localization, and M0 or T3 tumors (all P < .05). Adjuvant immunotherapy use was positively correlated with younger age and M1 tumors (all P < .05). CONCLUSIONS Although SR did not confer survival benefits in HNMM patients, SI and SRI yielded greater OS than surgery alone. SRI was associated with superior survival outcomes than SR. Certain demographic and clinical factors were associated with increased mortality risk. Patient age and certain tumor characteristics were predictors of adjuvant radiotherapy or immunotherapy use. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Tyler M Yasaka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Peter Papagiannopoulos
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Maie A St John
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jeremy P Harris
- Department of Radiation Oncology, University of California, Irvine, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
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14
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Ebner DK, Malouff TD, Frank SJ, Koto M. The Role of Particle Therapy in Adenoid Cystic Carcinoma and Mucosal Melanoma of the Head and Neck. Int J Part Ther 2021; 8:273-284. [PMID: 34285953 PMCID: PMC8270088 DOI: 10.14338/ijpt-d-20-00076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/11/2021] [Indexed: 12/24/2022] Open
Abstract
Particle irradiation is suitable for resistant histologies owing to a combination of improved dose delivery with potential radiobiologic advantages in high linear energy transfer radiation. Within the head and neck, adenoid cystic carcinoma and mucosal melanoma are two such histologies, being radioresistant and lying closely proximal to critical structures. Here, we review the use of particle irradiation for adenoid cystic carcinoma and mucosal melanoma of the head and neck.
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Affiliation(s)
- Daniel K Ebner
- Hospital of the National Institutes of Quantum and Radiological Science and Technology (QST Hospital), Chiba, Japan
| | - Timothy D Malouff
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Steven J Frank
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Masashi Koto
- Hospital of the National Institutes of Quantum and Radiological Science and Technology (QST Hospital), Chiba, Japan
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15
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Kim H, Lee S, Cha IH, Kim HJ, Nam W. Primary malignant mucosal melanoma of the maxillofacial area. J Korean Assoc Oral Maxillofac Surg 2021; 47:76-81. [PMID: 33911039 PMCID: PMC8084745 DOI: 10.5125/jkaoms.2021.47.2.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We aimed to collect and report data from all patients who have been diagnosed with mucosal malignant melanoma to obtain the epidemiology and principles of current treatments. MATERIALS AND METHODS Between January 2008 and December 2018, 20 patients underwent surgery or follow-up observations at Yonsei University Dental Hospital. The patients' clinical information was reviewed retrospectively. RESULTS Seventeen of 20 patients had undergone definitive surgery, while only 6 patients received adjuvant radiotherapy or systemic therapy. Eight of 20 patients, including those that had recurrent lesions, were provided immunotherapy. The 3-year survival for all stages was 50%, with a local recurrence rate of 75% and a metastasis rate of 65%. CONCLUSION The overall survival of patients receiving surgical treatment was longer than that of patients who did not undergo surgical resection. Eight of 20 patients received immunotherapy as the first-line regimen at our clinic, and those patients exhibited longer overall survival compared to patients in reported keynote studies.
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Affiliation(s)
- Hyounmin Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Sanghoon Lee
- Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
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16
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Elsamna ST, Ahsanuddin S, Mir GS, Sukyte-Raube D, Fang CH, Baredes S, Eloy JA. Surgical Margin Status and Survival Following Resection of Sinonasal Mucosal Melanoma. Laryngoscope 2021; 131:2429-2435. [PMID: 33864635 DOI: 10.1002/lary.29574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Sinonasal mucosal melanoma (SNMM) is an aggressive cancer usually managed with surgical resection. This study evaluates the impact of treatment modality and positive surgical margin (PSM) on survival following resection of SNMM. STUDY DESIGN Retrospective study of a national cancer registry. METHODS The National Cancer Database was queried for cases of SNMM from 2010 to 2015. Data regarding patient demographics, tumor staging, and treatment modality were obtained. Survival rates were compared by margin status: PSM, negative (NSM), and no operation (0SM) using Kaplan-Meier analysis and log rank test. RESULTS A total of 446 patients met inclusion criteria. Most cases were elderly (>66 years-old) (67.3%), female (54.3%), and white (89.5%). Cases of SNMM most commonly involved the nasal cavity (81.6%), were Stage 3 (60.0%), and underwent surgical resection at an academic center (65.0%). NSM and PSM were present in 59.0% and 26.9% of cases, respectively, while 14.1% of cases did not undergo surgical resection (0SM). Factors predictive of PSM included resection at a community hospital (OR 2.47) and Stage 4 disease (OR 2.07). The 2-year survival rates were 72.1% (95% CI 69.4-75.4%), 36.3% (95% CI 22.0-48.9), and 16.0% (95% CI 8.2-25.4%) for NSM, PSM and 0SM, respectively. Survival was statistically significant between NSM and PSM (Log rank <0.001) but not between 0SM and PSM (Log rank = 0.062). CONCLUSION Our study emphasizes the need for NSM for SNMM as PSM did not demonstrate any significant improvement in survival when compared to 0SM. Our findings suggest that cases of SNMM are best managed at academic centers. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Samer T Elsamna
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Salma Ahsanuddin
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Ghayoour S Mir
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Donata Sukyte-Raube
- Center of Ear, Nose, and Throat Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuana
| | - Christina H Fang
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, New Jersey, U.S.A
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17
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Sinonasal mucosal melanoma: treatment strategies and survival rates for a rare disease entity : A single center experience and review of literature. Wien Klin Wochenschr 2021; 133:1137-1147. [PMID: 33844113 PMCID: PMC8599389 DOI: 10.1007/s00508-021-01847-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022]
Abstract
Background Sinonasal mucosal melanoma (SNMM) is a rare disease entity comprising 0.4–1.3% of all melanomas. Surgery with free margins has been the primary treatment over decades. Neither the addition of radiotherapy nor chemotherapy could significantly improve outcome rates of this devastating malignancy. This study presents our clinical experience with SNMM over a 19-year period and summarizes the current body of literature on SNMM. Methods This retrospective analysis included 12 patients with SNMM treated from 2001 to 2019 at an academic center. Additionally, a literature review of the last 29 years on treatment and survival data of SNMM was conducted. Results Main initial symptoms were epistaxis and nasal obstruction. Of the patients 9 underwent endoscopic surgery, 6 received adjuvant therapy. 3 patients who did not undergo surgery, received chemoradiotherapy, radiotherapy alone, and chemotherapy alone, respectively. At the time of diagnosis 2 patients had distant metastases and 4 patients developed distant metastases during the course of the disease. Mean overall survival (OS) was 30.6 months, 3‑year and 5‑year OS were 25%, and 18.2%, respectively. Conclusion Unspecific symptoms and hidden anatomic locations lead to delayed diagnosis and increased rates of metastatic dissemination. Distant metastasis is the main treatment failure in SNMM. Surgery with free margins remains the primary treatment for SNMM. Adjuvant radiotherapy might improve local control in individual cases but efficient systemic therapy is needed to improve outcome rates. To evaluate and define more effective targeted treatment options and improve outcome rates, homogeneous data and prospective multicentric analysis are needed.
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18
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Laimer J, Bruckmoser E, Helten T, Kofler B, Zelger B, Brunner A, Zelger B, Huck CW, Tappert M, Rogge D, Schirmer M, Pallua JD. Hyperspectral imaging as a diagnostic tool to differentiate between amalgam tattoos and other dark pigmented intraoral lesions. JOURNAL OF BIOPHOTONICS 2021; 14:e202000424. [PMID: 33210464 DOI: 10.1002/jbio.202000424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 06/11/2023]
Abstract
The goal of this project is to identify any in-depth benefits and drawbacks in the diagnosis of amalgam tattoos and other pigmented intraoral lesions using hyperspectral imagery collected from amalgam tattoos, benign, and malignant melanocytic neoplasms. Software solutions capable of classifying pigmented lesions of the skin already exist, but conventional red, green and blue images may be reaching an upper limit in their performance. Emerging technologies, such as hyperspectral imaging (HSI) utilize more than a hundred, continuous data channels, while also collecting data in the infrared. A total of 18 paraffin-embedded human tissue specimens of dark pigmented intraoral lesions (including the lip) were analyzed using visible and near-infrared (VIS-NIR) hyperspectral imagery obtained from HE-stained histopathological slides. Transmittance data were collected between 450 and 900 nm using a snapshot camera mounted to a microscope with a halogen light source. VIS-NIR spectra collected from different specimens, such as melanocytic cells and other tissues (eg, epithelium), produced distinct and diagnostic spectra that were used to identify these materials in several regions of interest, making it possible to distinguish between intraoral amalgam tattoos (intramucosal metallic foreign bodies) and melanocytic lesions of the intraoral mucosa and the lip (each with P < .01 using the independent t test). HSI is presented as a diagnostic tool for the rapidly growing field of digital pathology. In this preliminary study, amalgam tattoos were reliably differentiated from melanocytic lesions of the oral cavity and the lip.
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Affiliation(s)
- Johannes Laimer
- University Hospital for Craniomaxillofacial and Oral Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Tom Helten
- University Hospital for Craniomaxillofacial and Oral Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Kofler
- University Hospital of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Brunner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Zelger
- University Hospital for Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian W Huck
- Institute of Analytical Chemistry and Radiochemistry, Leopold Franzens University of Innsbruck, Innsbruck, Austria
| | - Michelle Tappert
- Hyperspectral Intelligence Inc., Gibsons, British Columbia, Canada
| | - Derek Rogge
- Hyperspectral Intelligence Inc., Gibsons, British Columbia, Canada
| | - Michael Schirmer
- Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes D Pallua
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
- University Hospital for Orthopedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
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Donnell CC, Walton RL, Carrozzo M. The blue palate-A case series of imatinib-related oral pigmentation and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:49-61. [PMID: 33199217 DOI: 10.1016/j.oooo.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 12/28/2022]
Abstract
Pigmented oral mucosal lesions are diverse, and differential diagnosis can range from benign conditions such as oral melanotic macule to malignancies such as oral malignant melanoma. Imatinib mesylate is a tyrosine kinase inhibitor used as a first-line medication in the management of oncohematological conditions such as chronic myeloid leukemia and gastrointestinal stromal tumors. Side effects of imatinib therapy are common, and paradoxically imatinib has been associated with both hypo- and hyperpigmented lesions, the underlying mechanism for which is still unclear. Hyperpigmentation associated with imatinib therapy is a potentially underreported phenomenon. This article presents an in-depth, clinicopathological review of the literature surrounding imatinib-related hyperpigmentation, alongside a case series of imatinib-related oral pigmentation with notable practical learning points. A pragmatic flowchart to help clinicians in the diagnosis and management of oral pigmented lesions is provided, as well as advice on the application of the ABCDE criteria to standardize recording of oral pigmented lesions.
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Affiliation(s)
- Christopher C Donnell
- Dental Core Trainee, Newcastle Dental Hospital, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle, UK.
| | - Richard L Walton
- NIHR Academic Clinical Fellow, Specialty Trainee in Oral Medicine, Newcastle School of Dental Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Marco Carrozzo
- Professor, Honorary Consultant in Oral Medicine, Newcastle School of Dental Sciences Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
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Suresh S, George NA, Janardhan D, George PS, Patil S, George CK, Varghese BT, Ammu JV. Mucosal Melanomas of the Head and Neck—a Tertiary Cancer Centre Experience. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Soares CD, Carlos R, Andrade BABD, Cunha JLS, Agostini M, Romañach MJ, Hernandez-Guerrero JC, Mosqueda-Taylor A, Almeida OPD, Jorge J. Oral Amelanotic Melanomas: Clinicopathologic Features of 8 Cases and Review of the Literature. Int J Surg Pathol 2020; 29:263-272. [PMID: 32734791 DOI: 10.1177/1066896920946435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mucosal melanomas are aggressive tumors, rarely observed in the oral cavity. The diagnosis is based on the clinical and microscopical features. Often these tumors had variable amounts of melanin pigmentation. However, when melanin is absent, the tumors are denominated amelanotic, presenting a tendency to misdiagnosis and delayed treatment. The aim of this study was to describe the clinicopathologic features of a series of oral amelanotic melanomas (OAM). Records of all cases of OAM were retrospectively retrieved from oral pathology services from January 2002 to January 2019. Data regarding the clinical features, morphological aspects, immunohistochemical reactions, treatment, and follow-up status were collected. Eight cases of OAM were included, 6 in men and 2 in women (ratio of 3:1) ranging in age from 33 to 77 years (mean 53.6 years). Clinically, the tumors presented as masses or ulcerated swellings. The most common intraoral locations of the tumors were gingiva and palate. Cervical lymph node metastasis was detected in 3 patients at the first examination. All but one patient died from complications of the tumors after a mean follow-up period of 8.5 months. In conclusion, OAM is a very aggressive malignant tumor, and when melanin is absent, an immunohistochemical panel comprising S100, melan A, HMB45, and SOX10 should be performed.
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Affiliation(s)
| | - Román Carlos
- 389723Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | | | | | - Michelle Agostini
- 28125Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | | | | | - Jacks Jorge
- 28132University of Campinas, Piracicaba, São Paulo, Brazil
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22
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Almutuawa DM, Strohl MP, Gruss C, van Zante A, Yom SS, McDermott MW, El-Sayed IH. Outcomes of sinonasal mucosal melanomas with endoscopic and open resection: a retrospective cohort study. J Neurooncol 2020; 150:387-392. [PMID: 32227288 DOI: 10.1007/s11060-020-03449-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/04/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the outcomes of Sinonasal Mucosal Melanomas (SNMM) treated with endoscopic and open resection. METHODS A retrospective case review of 20 patients with SNMM treated surgically at UCSF. Kaplan-Meier analyses were calculated to determine outcome differences in endoscopic vs. open resections. RESULTS From 2005 to 2014, 20 cases of SNMM were confirmed and treated at UCSF. All cases underwent surgical resection, with 10 cases by open resection and 10 cases by endoscopic resection. Using Kaplan-Meier analyses, the open resection group had a 1-year survival of 30% whereas endoscopic resection group was 80% (p = 0.032). Endoscopic resection showed improved survival at all time points after surgery compared to open resection. CONCLUSION SNMM is a rare and aggressive tumor that is associated with low survival rates. In this small case series, endoscopic resection had improved survival outcomes compared to open resection.
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Affiliation(s)
- Deema M Almutuawa
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Calvin Gruss
- Department of Anesthesiology, Vanderbilt University, Nashville, TN, USA
| | - Annemieke van Zante
- Department of Pathology, University of California-San Francisco, San Francisco, CA, USA
| | - Sue S Yom
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | - Michael W McDermott
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, Center for Minimally Invasive Skull Base Surgery, University of California-San Francisco, 2233 Post St, 3rd Floor, San Francisco, CA, 94115, USA.
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Abstract
PURPOSE OF REVIEW While anti-PD-1 antibodies have been a breakthrough in the treatment of patients with advanced melanoma, a substantial proportion of patients are still refractory to or progress after treatment with anti-PD-1 immunotherapy. Here, we review the post anti-PD-1 therapy alternatives that may be possible for patients with unresectable or metastatic stage 3 or 4 melanoma. RECENT FINDINGS Currently available treatment options include BRAF-targeted and MEK inhibitor-targeted therapies for those with BRAFV600 mutant melanoma, while for patients with BRAF-WT melanoma or those who have already received prior BRAF-targeted therapy, options include anti-CTLA-4 therapy, alone or in combination with anti-PD-1 therapy, or for selected patients, clinical trials that may incorporate other immune checkpoint inhibitors or co-stimulatory agonists, oncolytic virotherapies, adoptive cellular therapies, or other novel agents. Participation in clinical trials is critical in order to delineate what more effective treatment options are and which group of patients after receiving prior anti-PD-1 therapy.
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24
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Farber NI, Bavier RD, Crippen MM, Vatsa N, Hsueh WD, Eloy JA. Comparing endoscopic resection and open resection for management of sinonasal mucosal melanoma. Int Forum Allergy Rhinol 2019; 9:1492-1498. [DOI: 10.1002/alr.22422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/20/2019] [Accepted: 08/02/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Nicole I. Farber
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
| | - Richard D. Bavier
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
| | - Meghan M. Crippen
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
| | - Nishant Vatsa
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
| | - Wayne D. Hsueh
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical School Newark NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical School Newark NJ
- Department of Neurological SurgeryRutgers New Jersey Medical School Newark NJ
- Department of Ophthalmology and Visual ScienceRutgers New Jersey Medical School Newark NJ
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25
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Colombino M, Paliogiannis P, Cossu A, De Re V, Miolo G, Botti G, Scognamiglio G, Ascierto PA, Santeufemia DA, Fraggetta F, Manca A, Sini MC, Casula M, Palomba G, Pisano M, Doneddu V, Lissia A, Fedeli MA, Palmieri G. BRAF Mutations and Dysregulation of the MAP Kinase Pathway Associated to Sinonasal Mucosal Melanomas. J Clin Med 2019; 8:jcm8101577. [PMID: 31581559 PMCID: PMC6832198 DOI: 10.3390/jcm8101577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 12/03/2022] Open
Abstract
Sinonasal mucosal melanoma (SNM) is a rare and aggressive type of melanoma, and because of this, we currently have a limited understanding of its genetic and molecular constitution. The incidence among SNMs of somatic mutations in the genes involved in the main molecular pathways, which have been largely associated with cutaneous melanoma, is not yet fully understood. Through a next-generation sequencing (NGS) approach using a panel of 25 genes involved in melanoma pathogenesis customized by our group, we performed a mutation analysis in a cohort of 25 SNM patients. Results showed that pathogenic mutations were found in more than 60% of SNM cases at a somatic level, with strikingly 32% of them carrying deleterious mutations in the BRAF gene. The identified mutations mostly lack the typical UV signature associated with cutaneous melanomas and showed no significant association with any histopathological parameter. Oncogenic activation of the BRAF-depending pathway, which may induce immune tolerance into the tumour microenvironment (i.e., by increasing the VEGF production) was poorly associated with mutations in genes that have been related to diminished clinical benefit of the treatment with BRAF inhibitors. Screening for mutations in BRAF and other MAPK genes should be included in the routine diagnostic test for a better classification of SNM patients.
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Affiliation(s)
- Maria Colombino
- Institute of Biomolecular Chemistry, National Research Council (CNR), Traversa La Crucca 3, 07100 Sassari, Italy.
| | - Panagiotis Paliogiannis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale S., 07100 Sassari, Italy.
| | - Antonio Cossu
- Anatomia Patologica, Azienda Ospedaliero Universitaria (AOU), 07100 Sassari, Italy.
| | - Valli De Re
- Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico (CRO), 33081 Pordenone, Italy.
| | - Gianmaria Miolo
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), 33081 Pordenone, Italy.
| | - Gerardo Botti
- Istituto Nazionale Tumori "Fondazione Pascale", 80131 Naples, Italy.
| | | | | | | | - Filippo Fraggetta
- Anatomia Patologica, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy.
| | - Antonella Manca
- Institute of Biomolecular Chemistry, National Research Council (CNR), Traversa La Crucca 3, 07100 Sassari, Italy.
| | - Maria Cristina Sini
- Institute of Biomolecular Chemistry, National Research Council (CNR), Traversa La Crucca 3, 07100 Sassari, Italy.
| | - Milena Casula
- Institute of Biomolecular Chemistry, National Research Council (CNR), Traversa La Crucca 3, 07100 Sassari, Italy.
| | - Grazia Palomba
- Institute of Biomolecular Chemistry, National Research Council (CNR), Traversa La Crucca 3, 07100 Sassari, Italy.
| | - Marina Pisano
- Institute of Biomolecular Chemistry, National Research Council (CNR), Traversa La Crucca 3, 07100 Sassari, Italy.
| | - Valentina Doneddu
- Anatomia Patologica, Azienda Ospedaliero Universitaria (AOU), 07100 Sassari, Italy.
| | - Amelia Lissia
- Anatomia Patologica, Azienda Ospedaliero Universitaria (AOU), 07100 Sassari, Italy.
| | | | - Giuseppe Palmieri
- Institute of Biomolecular Chemistry, National Research Council (CNR), Traversa La Crucca 3, 07100 Sassari, Italy.
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26
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Current concepts in advanced sinonasal mucosal melanoma: a single institution experience. Eur Arch Otorhinolaryngol 2019; 276:2259-2265. [PMID: 31098872 DOI: 10.1007/s00405-019-05458-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To present outcome measures of sinonasal mucosal melanoma (SMM) patients with particular focus on current radiological and therapeutic options, especially in the non-curative setting (immunotherapy). METHODS Retrospective study on SMM patients treated at our institution between January 1992 and December 2018. RESULTS FDG-PET/MRI has emerged as the new hybrid imaging modality, addressing the need for high local tissue contrast in the paranasal sinuses and the skull base, while allowing for whole-body staging in search for distant metastases, including the brain. Primary treatment protocols consisted of tumor resection in 30/34 patients (88%), palliative radiation therapy (RT) in 3/34 patients (9%) and best supportive care therapy in 1/34 patient (3%). Of all the initially operated patients, 25/30 patients (83%) received adjuvant RT. A total of 9/34 patients (26%) was treated with immunotherapy after the previous combined therapy. For patients treated in curative intention, we observed a 1-year overall survival (OS) of 60% (18/30 patients) and a 3-year OS of 40% (12/30 patients). For patients treated with immunotherapy, median progression-free survival (PFS) was 5 months (IQR 0-13.75), with a maximum PFS of 16 months (combination of nivolumab and ipilimumab). However, there was no difference in OS in patients treated with immunotherapy vs. no immunotherapy (log rank 0.99). CONCLUSIONS Sinonasal mucosal melanoma is a highly aggressive tumor, requiring multimodal therapy and developing a substantial incidence of distant metastases. The introduction of FDG-PET/MRI offers new possibilities in the radiological assessment of the tumor and immunotherapy has altered the management in the non-curative setting, resulting in a substantial progression-free survival in selected cases.
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27
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Low CM, Price DL, Moore EJ, Stokken JK, Van Abel KM, Janus JR, Choby G. Nodal and distant metastases in sinonasal mucosal melanoma: A population-based analysis. Laryngoscope 2019; 130:622-627. [PMID: 31077407 DOI: 10.1002/lary.28065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/03/2019] [Accepted: 04/23/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS Sinonasal mucosal melanoma (SNMM) is a rare malignant neoplasm. No study to date has analyzed the impact that nodal metastases and distant metastases at diagnosis have on overall survival (OS) and disease-specific survival (DSS). STUDY DESIGN Retrospective database review. METHODS The Surveillance, Epidemiology, and End Results database was queried for cases of SNMM. Descriptive statistics were used analyze patient demographic and clinicopathologic variables. The Kaplan-Meier model was used to analyze survival, and the Cox proportional hazards model was used for multivariate analysis. RESULTS Three hundred twenty-eight cases of SNMM were identified. The most frequent sinonasal anatomic location was the nasal cavity in 279 (73.0%) patients, followed by the maxillary sinus in 60 (15.7%) patients. Regional nodal metastases at diagnosis occurred in 33 (8.6%) patients, whereas distant metastases at diagnosis occurred in 41 (10.7%) patients. Five-year OS was 22.7%, and 5-year DSS was 26.8%. The presence of positive nodes at diagnosis (OS P < .0001, DSS P < .0001), distant metastases at diagnosis (OS P = .0442, DSS P = .0442), primary tumor site (OS P < .0001, DSS P < .0001), and increasing age (OS P = .0012, DSS P = .0016) were found to be significant as negative predictors of OS and DSS. CONCLUSIONS SNMM is a rare pathologic entity with a poor prognosis. The presence of nodal and distant metastases at diagnosis are negative prognostic factors in OS and DSS. These factors can be used in the development of new models of risk stratification and to inform treatment strategies and surveillance patterns. LEVEL OF EVIDENCE NA Laryngoscope, 130:622-627, 2020.
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Affiliation(s)
- Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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28
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Soares CD, de Lima Morais TM, Mariano FV, Altemani A, Corrêa MB, Reis RRDD, Amorim LS, Ferreira SMS, de Almeida OP, Carlos R, Jorge J. Expression of mitochondrial dynamics markers during melanoma progression: Comparative study of head and neck cutaneous and mucosal melanomas. J Oral Pathol Med 2019; 48:373-381. [PMID: 30916813 DOI: 10.1111/jop.12855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/25/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Head and neck mucosal melanomas (MMs) are rare tumors with adverse outcomes and poorer prognoses than their more common cutaneous counterparts (cutaneous melanomas-CMs). Few studies have compared the expression of mitochondrial dynamic markers in these tumors. This study aimed to assess the correlations of mitochondrial markers with melanoma progression and their potential as predictors of lymph node involvement and distant metastasis. METHODS Immunohistochemistry against anti-mitochondrial (AMT), dynamin-related protein 1 (DRP1), mitochondrial fission protein 1 (FIS1), mitofusin-1 (MFN1), and mitofusin-2 (MFN2) antibodies was performed in 112 cases of head and neck CM and MM. A Cox regression multivariate model was used to assess the correlation of AMT, FIS1, and MFN2 expressions considering the risk for nodal and distant metastasis. RESULTS All markers studied presented higher staining in tumor cells than normal adjacent tissues. Higher mitochondrial content was observed in MM than in CM, and it was significantly associated with nodal metastasis in oral melanomas. Both FIS1 and DRP1 expressions were related to advanced Clark's levels in CM, and they were overexpressed in oral melanomas. Moreover, increased immunoexpression of MFN2 was significantly associated with a higher risk of metastasis in CM, and it was also overexpressed in sinonasal melanomas. CONCLUSIONS Our results suggest that mitochondrial fission and fusion processes can play an important role during multiple stages of tumorigenesis and the development of nodal and distant metastasis in cutaneous and mucosal melanomas.
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Affiliation(s)
- Ciro Dantas Soares
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Thayná Melo de Lima Morais
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Fernanda Viviane Mariano
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.,Department of Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Albina Altemani
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.,Department of Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Marcelo Brum Corrêa
- Head and Neck Surgery Department, Oncology Center (CEON), Fornecedores de Cana Hospital, Piracicaba, São Paulo, Brazil
| | | | | | - Sonia Maria Soares Ferreira
- Infectious and Parasitic Diseases Unit, University Hospital of the Federal University of Alagoas, Maceió, Alagoas, Brazil.,Program of Research in Health, Centro Universitário Cesmac, Maceió, Alagoas, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Roman Carlos
- Pathology Division, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Jacks Jorge
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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29
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Sayed Z, Migliacci JC, Cracchiolo JR, Barker CA, Lee NY, McBride SM, Tabar VS, Ganly I, Patel SG, Morris LT, Roman BR, Shoushtari AN, Cohen MA. Association of Surgical Approach and Margin Status With Oncologic Outcomes Following Gross Total Resection for Sinonasal Melanoma. JAMA Otolaryngol Head Neck Surg 2019; 143:1220-1227. [PMID: 29049462 DOI: 10.1001/jamaoto.2017.2011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Zafar Sayed
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jocelyn C Migliacci
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Viviane S Tabar
- Neurosurgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal G Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc T Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin R Roman
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander N Shoushtari
- Neurosurgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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30
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Yang L, Ji S, Wang L, Zhang Y. Episcleritis in a patient with mucosal melanoma treated with interferon alfa-2b and radiotherapy: a case report. J Med Case Rep 2018; 12:388. [PMID: 30579358 PMCID: PMC6304235 DOI: 10.1186/s13256-018-1913-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/04/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mucosal melanoma of the head and neck is a rare malignant tumor associated with a poor prognosis. Surgery, chemotherapy, radiotherapy, and biotherapy are common strategies for treating mucosal melanoma of the head and neck. Episcleritis is an idiopathic, immune-mediated disease, and is classified into two types: simple episcleritis and nodular episcleritis. CASE PRESENTATION In this case report we describe ocular changes involving simple episcleritis in a 65-year-old Chinese man with mucosal melanoma of the head and neck after treatment with interferon alfa-2b and radiotherapy. On the third day of interferon alfa-2b treatment, he began to develop simple episcleritis in his left eye. Moreover, the percentage of CD3+ T cells in lymphocytes from blood was increased after interferon alfa-2b treatment. After approximately 6 days, the symptoms of eye pain, hyperemia, and edema disappeared gradually. Then, after radiotherapy was performed three times, he again developed episcleritis in his left eye. The same symptoms of hyperemia and edema occurred again; CD3+ T cell frequency was also at a higher level. After approximately a week, all the symptoms disappeared completely. Simple treatment involving topical ofloxacin and phenylephrine was administered during the two periods of episcleritis. CONCLUSION Episcleritis in this patient might have been due to the treatment with interferon alfa-2b and radiotherapy, leading to an increase in the level of CD3+ T cells and activation of immune system cells, which provides the guide for clinical clinicians.
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Affiliation(s)
- Li Yang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Shaofei Ji
- Department of Radiology, Orthopedics Hospital of Zhengzhou City, Zhengzhou, 450052, China
| | - Liping Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yi Zhang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China. .,Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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31
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Soares C, Melo de Lima Morais T, Carlos R, Mariano FV, Altemani A, Freire de Carvalho MG, Corrêa MB, Dias Dos Reis RR, Amorim LS, Paes de Almeida O, Jorge J. Phosphorylated Akt1 expression is associated with poor prognosis in cutaneous, oral and sinonasal melanomas. Oncotarget 2018; 9:37291-37304. [PMID: 30647870 PMCID: PMC6324666 DOI: 10.18632/oncotarget.26458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023] Open
Abstract
Melanomas are highly aggressive tumours derived from melanocytes, which occur most commonly in the skin. Occasionally, these tumours may appear in oral and sinonasal mucous membranes. In this study, we performed a comparative analysis of the Phosphorylated Akt1 (p-Akt1) expression in 144 patients affected by cutaneous (CM), 34 oral cavity (OM), and 31 sinonasal melanomas (SNM). Similar to the metastatic cutaneous melanomas, p-Akt1 was overexpressed in 17/34 of the oral cavity and 20/31 of the sinonasal melanomas. In addition, the p-Akt1-nuclear expression was associated with poorer cancer-specific survival in cutaneous (P < .0001), oral (P < .0001), and sinonasal (P = .001) melanomas. Multivariate analysis showed p-Akt1 to be an independent prognostic marker in oral (P = .041) and sinonasal (P < .0001) melanomas patients. In conclusion, p-Akt1 overexpression is an independent prognostic marker in mucosal melanomas and is significantly up-regulated in sinonasal melanomas. As both mucosal and metastatic cutaneous melanomas showed high frequency of p-Akt1 expression, these findings suggest that mucosal melanomas have a biological behaviour, similar to the aggressive cutaneous melanomas.
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Affiliation(s)
- Ciro Soares
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Thayná Melo de Lima Morais
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Roman Carlos
- Pathology Division, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Fernanda Viviane Mariano
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.,Department of Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Albina Altemani
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.,Department of Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Marcelo Brum Corrêa
- Head and Neck Surgery Department - Oncology Center (CEON), Fornecedores de Cana Hospital, Piracicaba, São Paulo, Brazil
| | | | | | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Jacks Jorge
- Department of Oral Diagnosis, Area of Pathology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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32
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Laimer J, Henn R, Helten T, Sprung S, Zelger B, Zelger B, Steiner R, Schnabl D, Offermanns V, Bruckmoser E, Huck CW. Amalgam tattoo versus melanocytic neoplasm - Differential diagnosis of dark pigmented oral mucosa lesions using infrared spectroscopy. PLoS One 2018; 13:e0207026. [PMID: 30399191 PMCID: PMC6219804 DOI: 10.1371/journal.pone.0207026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Dark pigmented lesions of the oral mucosa can represent a major diagnostic challenge. A biopsy is usually required to determine the nature of such intraoral discolorations. This study investigates the potential use of infrared spectroscopy for differential diagnosis of amalgam tattoos versus benign or malignant melanocytic neoplasms. Materials and methods For this retrospective study, formalin-fixed paraffin-embedded tissue (FFPE) specimens of dark pigmented lesions concerning the oral mucosa or the lip were investigated using mid infrared spectroscopy. The samples were chosen from patients who had undergone a mucosal biopsy at the University Hospital Innsbruck (Austria) between the years 2000 and 2017. Principal component analysis was used for data exploration. Evaluation was based on the superimposition of the recorded spectra and the corresponding histologic slides. Results In total, 22 FFPE specimens were analyzed. Clear differences were found between amalgam and non-amalgam samples. A general weakening of the penetrating infrared radiation allowed for unspecific discrimination between these two classes. An overall accuracy in predicting the correct class of 95.24% was achieved. Conclusion Infrared spectroscopy appears to be a suitable technique to differentiate between amalgam tattoos and melanocytic lesions in FFPE samples. It could potentially be applied in vivo, too, serving as a non-invasive diagnostic tool for intraoral dark pigmented lesions.
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Affiliation(s)
- Johannes Laimer
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | - Raphael Henn
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
| | - Tom Helten
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | - Susanne Sprung
- Institute of Pathology, Medical University, Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Medical University, Innsbruck, Austria
| | - Bernhard Zelger
- University Hospital for Dermatology, Venereology and Allergology, Innsbruck, Austria
| | - René Steiner
- University Hospital for Dental Prosthetics and Restorative Dentistry, Innsbruck, Austria
| | - Dagmar Schnabl
- University Hospital for Dental Prosthetics and Restorative Dentistry, Innsbruck, Austria
| | - Vincent Offermanns
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | | | - Christian W. Huck
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
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Mahmoud MM, Madi M, Gamal R. Uncommon clinical presentation of oral malignant melanoma. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2018. [DOI: 10.1016/j.bjbas.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Luna-Ortiz K, Villavicencio-Valencia V, Martinez Said H. Comparative study of head and neck mucosal melanoma in 66 patients vs 226 patients with cutaneous melanoma: A survival analysis. Clin Otolaryngol 2018; 43:691-696. [PMID: 28986955 DOI: 10.1111/coa.13000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 12/12/2022]
Affiliation(s)
- K Luna-Ortiz
- Department of Head and Neck Surgery, Instituto Nacional de Cancerologia, Mexico City, Mexico
- Department of General Surgery (Head & Neck), Hospital General Manuel Gea Gonzalez, Mexico City, Mexico
| | - V Villavicencio-Valencia
- Department of Skin and Soft Tissue Sarcomas and Melanomas, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - H Martinez Said
- Department of General Surgery (Head & Neck), Hospital General Manuel Gea Gonzalez, Mexico City, Mexico
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The Tumor Suppressor p53 in Mucosal Melanoma of the Head and Neck. Genes (Basel) 2017; 8:genes8120384. [PMID: 29236030 PMCID: PMC5748702 DOI: 10.3390/genes8120384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022] Open
Abstract
Despite worldwide prevention programs, the incidence for cutaneous melanoma is continuously increasing. Mucosal melanoma (MM) represents a rare but highly aggressive phenotype of common melanoma with predilection in the sinonasal system. Far away from ultraviolet sun exposure, the molecular mechanisms underlying tumorigenesis and the highly aggressive clinical behavior are poorly understood. In many solid malignomas of the head and neck region, p53 tumor suppressor functions as oncogene due to p53 protein stabilizing mutation. Interestingly, the vast majority of MM demonstrates constitutively expressed p53 protein, with protein stabilizing mutations being rare. Abrogated activation of p53 target genes results in derogation of the apoptotic signal cascade and contributes to the strong resistance against chemotherapeutic agents activating p53 dependent apoptosis. The current review illustrates the role of p53 and its pathway in MM.
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Schmidt MQ, David J, Yoshida EJ, Scher K, Mita A, Shiao SL, Ho AS, Zumsteg ZS. Predictors of survival in head and neck mucosal melanoma. Oral Oncol 2017; 73:36-42. [DOI: 10.1016/j.oraloncology.2017.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 02/08/2023]
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Lohia S, Boersma I, Lentsch E. Primary malignant melanoma of the larynx—A case report. OTOLARYNGOLOGY CASE REPORTS 2017. [DOI: 10.1016/j.xocr.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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38
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Alves ISS, Berriel LGS, Alves RT, Pinto MB, Oliveira CFP, Cazzotto AC, Moura WV. Sinonasal Melanoma: A Case Report and Literature Review. Case Rep Oncol Med 2017; 2017:8201301. [PMID: 28255482 PMCID: PMC5306975 DOI: 10.1155/2017/8201301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/02/2017] [Accepted: 01/10/2017] [Indexed: 12/22/2022] Open
Abstract
Purpose. Sinonasal malignant mucosal melanoma is a rare, aggressive tumour. Nasal obstruction and epistaxis are the most commonly reported symptoms, although symptomatology may develop late and be nonspecific, which tends to delay diagnosis, resulting in a poorer prognosis. Case Report. This report describes a 64-year-old male patient with nasal obstruction and epistaxis. Computed tomography of the facial sinuses revealed a large lesion in the right nasal cavity, with infiltration into the left cavity, ethmoidal cells, and erosion of the cribriform plate. Initial incisional biopsy revealed an undifferentiated carcinoma of the right maxillary sinus, staged as T4aN0M0. Induction chemotherapy was initiated with cisplatin and etoposide. Response to treatment was complete. The patient was then submitted to radiotherapy with concomitant cisplatin. Immunochemical analysis revealed positivity for vimentin, S100, and HMB-45 (human melanoma black 45), a result compatible with a diagnosis of malignant melanoma. Discussion. Due to the rarity of the tumour and the patient's complete response to chemotherapy and since no blackened lesion had been found at the previous exam, treatment was continued as planned. The patient remains healthy, with no metastasis or recurrence. He is currently being monitored by the clinical oncology team.
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Affiliation(s)
- I. S. S. Alves
- Hospital Universitário Cassiano Antônio de Moraes, Santos Dumont, ES, Brazil
| | - L. G. S. Berriel
- Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | - R. T. Alves
- Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | - M. B. Pinto
- Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | | | - A. C. Cazzotto
- Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | - W. V. Moura
- Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
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Green B, Elhamshary A, Gomez R, Rahimi S, Brennan PA. An update on the current management of head and neck mucosal melanoma. J Oral Pathol Med 2017; 46:475-479. [DOI: 10.1111/jop.12526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Ben Green
- Department of Gastroenterology; Torbay Hospital; Torquay UK
| | - Ahmed Elhamshary
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| | - Ricardo Gomez
- Department of Oral Surgery & Pathology; School of Dentistry; Universidade Federal de Minas Gerais-UFMG; Belo-Horizonte Brazil
| | - Siavash Rahimi
- Department of Histopathology; Queen Alexandra Hospital; Portsmouth UK
| | - Peter A. Brennan
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
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Kumar V, Vishnoi JR, Kori CG, Gupta S, Misra S, Akhtar N. Primary malignant melanoma of oral cavity: A tertiary care center experience. Natl J Maxillofac Surg 2016; 6:167-71. [PMID: 27390490 PMCID: PMC4922226 DOI: 10.4103/0975-5950.183856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Primary mucosal malignant melanoma is an extremely rare, aggressive neoplasm accounting for 0.5% of all oral malignancies. Any pigmented lesion in oral cavity should have an index of suspicion, which should be investigated to detect the disease at an early stage and managed appropriately. Melanomas tend to invade locally into the tissue or metastasize more commonly than other malignant tumors of the oral cavity. Materials and Methods: We report a retrospective case series of eight patients suffering from primary oral malignant melanoma treated in our department between 2012 and 2014. The details were recorded from the departmental computerized database and patients on follow-up. Results: There were six male and two female patients with a mean age of 46.8 years. Hard palate was the most common affected site in oral cavity. Pigmented lesion\ulcer was the most common presenting symptom. Majority of patients (5 patients) were diagnosed with Stage III (distant metastasis), two patients in Stage II, and one patient in Stage I. Three patients were treated with definitive surgery and five patients with palliative chemotherapy in view of distant disease. Following surgery, two of them required adjuvant chemoradiotherapy in view of nodal spread. Patients had a mean follow-up of 10.5 months (range: 8–26 months). Patients treated with definitive surgery had a mean survival rate of 16 months (range: 10–26 months), with local recurrence in one patient. Metastatic melanoma patients treated with palliative chemotherapy had a mean disease control rate of 5 months (range 5–9 months). Conclusion: Oral melanoma carries dismal prognosis with a 5-year survival rate of 5–20%. Early detection of the lesion, proper evaluation, and appropriate treatment are very important to cure the disease.
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Affiliation(s)
- Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jeewan Ram Vishnoi
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Channabasappa G Kori
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sameer Gupta
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
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41
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Moctezuma-Bravo GS, Díaz de León-Medina R, Rodríguez-Quilantán FJ, Salgado-Nevárez MS, Moctezuma-Dávila M. Melanoma nasomaxilar: revisión de la literatura y reporte de un caso. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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42
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Hwang JH, Ha JB, Lee J, Lee J. Concurrent Mucosal Melanoma and Angiofibroma of the Nose. Clin Exp Otorhinolaryngol 2016; 9:278-81. [PMID: 27095516 PMCID: PMC4996105 DOI: 10.21053/ceo.2015.01333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/24/2015] [Accepted: 12/08/2015] [Indexed: 11/22/2022] Open
Abstract
Malignant melanoma rarely develops in the paranasal sinuses, and generally has a poor prognosis. However, mucosal melanoma can masquerade both clinically and histopathologically as a benign lesion, rendering accurate early diagnosis difficult. On the other hand, angiofibroma, a benign tumor, is more easily diagnosed than a mucosal melanoma, because the former exhibits specific histopathological features. No cases of concurrent angiofibroma and mucosal melanoma have been reported to date. We describe such a case below.
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Affiliation(s)
- Jae Hyung Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery,The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Bu Ha
- Department of Otorhinolaryngology-Head and Neck Surgery,The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Junguee Lee
- Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joohyung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery,The Catholic University of Korea College of Medicine, Seoul, Korea
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Grünmüller L, Thierauf J, Weissinger SE, Bergmann C, Bankfalvi A, Veit J, Hoffmann TK, Möller P, Lennerz JK. Biopanel identifies expression status of targetable proteins in sinonasal melanoma. Per Med 2016; 13:291-301. [PMID: 29749817 DOI: 10.2217/pme-2016-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Advanced stage at presentation, lack of BRAF mutations and overall rarity pose unique challenges to the therapy and trial design in sinonasal melanoma. METHODS Here, we assessed the expression status of 12 proteins in two independent cohorts of sinonasal melanoma (n = 20). RESULTS Each case showed expression of at least one protein (KIT, TP53, MYC, HER2, EGFR, MET, VEGFR, BRAF V600E and/or MDM2), whereas lack of ALK, FLI1 and PDGFRα expression underscores differences to cutaneous melanoma. Comparison of marker frequencies to a metareview of the literature indicates that MYC, HER2, EGFR and MET had not been previously assessed. CONCLUSION Expression of at least one potentially targetable protein per case illustrates proteome pathway profiling as one starting point for marker stratified trial design.
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Affiliation(s)
| | - Julia Thierauf
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | | | | | - Agnes Bankfalvi
- Department of Pathology, University Hospital Essen, Essen, Germany
| | - Johannes Veit
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Peter Möller
- Institute of Pathology, Ulm University, Ulm, Germany
| | - Jochen K Lennerz
- Institute of Pathology, Ulm University, Ulm, Germany.,Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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44
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Zhu W, Zou B, Wang S. Clinicopathological Features and Prognosis of Sinonasal Mucosal Malignant Melanoma: A Retrospective Study of 83 Cases in a Chinese Population. ORL J Otorhinolaryngol Relat Spec 2016; 78:94-104. [PMID: 26978564 DOI: 10.1159/000444500] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022]
Abstract
AIMS Sinonasal mucosal malignant melanoma (SNMMM) is a rare disease. The aim of the present study was to describe its clinicopathological features and prognosis in a Chinese population. METHODS Data on 83 SNMMM patients were collected and analyzed. A survival analysis was performed using the Kaplan-Meier method and a log-rank test. RESULTS The most common presenting symptoms of SNMMM were nasal obstruction, epistaxis, and bloody rhinorrhea. Histopathologically, 38 cases (45.78%) were amelanotic. Five cell types (epithelioid, undifferentiated, plasmacytoid, spindle, and clear) were identified. Positive staining for human melanoma black-45 and Melan-A was diagnostic of SNMMM. Advanced age, multiple tumor sites, and amelanotic-type SNMMM indicated a worse outcome (p = 0.008, p = 0.009, and p = 0.013, respectively). Neither adjuvant therapy nor the tumor stage was associated with overall survival. CONCLUSIONS SNMMM is an uncommon disease with atypical symptoms. Its histopathological appearance is variable, especially in the amelanotic type. Thus, immunohistochemistry is important in the diagnosis, and it should be performed according to the histology.
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Affiliation(s)
- Wenjia Zhu
- Department of Pathology, Eye and ENT Hospital, Fudan University, Shanghai, China
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45
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Martinelli-Kläy CP, Laporte ML, Martinelli CR, Martinelli C, Lombardi T. Oral Malignant Melanoma Initially Misdiagnosed as a Racial Pigmentation: A Case Report. Dermatopathology (Basel) 2016; 3:1-7. [PMID: 27195264 PMCID: PMC4868936 DOI: 10.1159/000444049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Oral malignant melanoma (OMM) is rare, representing less than 0.5% of all oral malignancies. The most affected sites are the palate and the maxillary gingiva. Histological examination is important to establish the diagnosis of any suspicious pigmented lesion in the oral cavity, mainly if a precise clinical diagnosis is not possible. We present one case of OMM that was initially diagnosed as a racial pigmentation elsewhere 2 years earlier. Clinical examination showed multiple macules and nodules located on the hard and soft palate, gingiva and superior alveolar mucosa. These lesions were painless and presented a color variation going from dark blue to black. Histological analysis showed sheets and nests of atypical melanocytes displaying a range of shapes such as plasmacytoid, epithelioid, and round cells, located in the superficial corium extending to the deep tissues. A few tumor cells contained variable amounts of melanin. There was no invasion of blood vessels or nerve fibers. Immunohistochemical analysis revealed that the neoplastic cells were positive for HMB-45, melan-A, S-100 and negative for AE1/AE3, confirming the diagnosis of melanoma. The Ki-67 labeling index was around 25%. The patient refused any treatment and died 11 months later.
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Affiliation(s)
- Carla Patrícia Martinelli-Kläy
- Oral Medicine and Oral Maxillofacial Pathology Unit, Division of Oral Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Geneva, Geneva, Switzerland; Centre for Diagnosis and Treatment of Oral Diseases, Ribeirão Preto, Brazil
| | - Marcel Leandro Laporte
- Oral Medicine and Oral Maxillofacial Pathology Unit, Division of Oral Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Geneva, Geneva, Switzerland
| | | | - Celso Martinelli
- Centre for Diagnosis and Treatment of Oral Diseases, Ribeirão Preto, Brazil
| | - Tommaso Lombardi
- Oral Medicine and Oral Maxillofacial Pathology Unit, Division of Oral Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Geneva, Geneva, Switzerland
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Gawron K, Łazarz-Bartyzel K, Potempa J, Chomyszyn-Gajewska M. Gingival fibromatosis: clinical, molecular and therapeutic issues. Orphanet J Rare Dis 2016; 11:9. [PMID: 26818898 PMCID: PMC4729029 DOI: 10.1186/s13023-016-0395-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/20/2016] [Indexed: 12/28/2022] Open
Abstract
Gingival fibromatosis is a rare and heterogeneous group of disorders that develop as slowly progressive, local or diffuse enlargements within marginal and attached gingiva or interdental papilla. In severe cases, the excess tissue may cover the crowns of the teeth, thus causing functional, esthetic, and periodontal problems, such as bone loss and bleeding, due to the presence of pseudopockets and plaque accumulation. It affects both genders equally. Hereditary, drug-induced, and idiopathic gingival overgrowth have been reported. Hereditary gingival fibromatosis can occur as an isolated condition or as part of a genetic syndrome. The pathologic manifestation of gingival fibromatosis comprises excessive accumulation of extracellular matrix proteins, of which collagen type I is the most prominent example. Mutation in the Son-of-Sevenless-1 gene has been suggested as one possible etiological cause of isolated (non-syndromic) hereditary gingival fibromatosis, but mutations in other genes are also likely to be involved, given the heterogeneity of this condition. The most attractive concept of mechanism for drug-induced gingival overgrowth is epithelial-to-mesenchymal transition, a process in which interactions between gingival cells and the extracellular matrix are weakened as epithelial cells transdifferentiate into fibrogenic fibroblast-like cells. The diagnosis is mainly made on the basis of the patient's history and clinical features, and on histopathological evaluation of affected gingiva. Early diagnosis is important, mostly to exclude oral malignancy. Differential diagnosis comprises all pathologies in the mouth with excessive gingival overgrowth. Hereditary gingival fibromatosis may present as an autosomal-dominant or less commonly autosomal-recessive mode of inheritance. If a systemic disease or syndrome is suspected, the patient is directed to a geneticist for additional clinical examination and specialized diagnostic tests. Treatments vary according to the type of overgrowth and the extent of disease progression, thus, scaling of teeth is sufficient in mild cases, while in severe cases surgical intervention is required. Prognosis is precarious and the risk of recurrence exists.
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Affiliation(s)
- Katarzyna Gawron
- Microbiology Department, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 30-387, Krakow, Poland.
| | - Katarzyna Łazarz-Bartyzel
- Department of Periodontology and Oral Medicine, Jagiellonian University, Medical College, Institute of Dentistry, 30-387, Krakow, Poland.
| | - Jan Potempa
- Microbiology Department, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 30-387, Krakow, Poland.
- Oral Health and Systemic Disease Research Group, School of Dentistry, University of Louisville, Louisville, KY, USA.
| | - Maria Chomyszyn-Gajewska
- Department of Periodontology and Oral Medicine, Jagiellonian University, Medical College, Institute of Dentistry, 30-387, Krakow, Poland.
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Fort M, Guet S, Husheng S, Calitchi E, Belkacemi Y. Role of radiation therapy in melanomas: Systematic review and best practice in 2016. Crit Rev Oncol Hematol 2016; 99:362-75. [PMID: 26829895 DOI: 10.1016/j.critrevonc.2016.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/02/2015] [Accepted: 01/16/2016] [Indexed: 12/11/2022] Open
Abstract
Radiotherapy has been used for skin cancers since early after the discovery of X-rays. The introduction of sophisticated surgery techniques and information of the general population on potential late radiation-induced toxicity and carcinogenesis have led to limiting indications in the dermatologist community. However, radiotherapy (RT) has undergone considerable developments, essentially including technological advances, to sculpt radiation delivery, with demonstration of the benefit either alone or after adding concomitant cytotoxic agents or targeted therapies. Although side effects due to high doses and/or the use of old RT techniques have been significantly decreased, the risk of atrophic scars, ulcerations or secondary cancers persist. In this systematic review, we aim to discuss indications for RT in melanomas with focus on new advances that may lead to rehabilitating this treatment option according to the tumor radiosensitivity and clinical benefit/risk ratio. Melanomas have been considered as radioresistant tumors for many years.
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Affiliation(s)
- Magali Fort
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Saada Guet
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Shan Husheng
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Elie Calitchi
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France; Henri Mondor Breast Center and University of Paris-Est Creteil (UPEC), Créteil, France
| | - Yazid Belkacemi
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France; Henri Mondor Breast Center and University of Paris-Est Creteil (UPEC), Créteil, France.
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Chatzistefanou I, Kolokythas A, Vahtsevanos K, Antoniades K. Primary mucosal melanoma of the oral cavity: current therapy and future directions. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:17-27. [PMID: 27039005 DOI: 10.1016/j.oooo.2016.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Primary mucosal melanoma of the oral cavity is a highly aggressive malignancy of melanocytic origin. The aim of this study is to report a case series of oral mucosal melanomas (OMMs) and provide a review of the literature with regard to treatment guidelines for and prognosis of this pathologic entity. STUDY DESIGN We report three cases of OMMs treated in our institutions and the results of a literature review, in which the words "oral" and "mucosal melanoma" were used as the main keywords. RESULTS Surgical resection of the primary tumor with wide resection margins appears to be the recommended primary treatment modality with the aim to achieve tumor-free margins. Elective neck dissection and adjuvant radiotherapy have been advocated for locoregional control. Chemotherapy has not been shown to improve survival and is mainly used for palliative purposes. Immunotherapy and biochemotherapy seem to significantly improve survival and could open new therapeutic horizons. CONCLUSIONS The prognosis of OMMs remains poor despite treatment. Early diagnosis and aggressive surgical resection followed by adjuvant therapies could be the key to improving survival. Multicenter randomized clinical trials, which may be difficult to conduct because of the rarity to the lesion, would aid in the development of new strategies.
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Affiliation(s)
- Ioannis Chatzistefanou
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Antonia Kolokythas
- Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, New York, USA.
| | - Konstantinos Vahtsevanos
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Konstantinos Antoniades
- Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, New York, USA
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Abstract
The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology. Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.
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Affiliation(s)
- Antonio Cardesa
- University of Barcelona, Anatomic Pathology Hospital Clínic University of Barcelona, Barcelona, Spain
| | - Pieter J. Slootweg
- Radboud Univ Nijmegen Medical Center, Pathology Radboud Univ Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nina Gale
- University of Ljubljana,, Institute of Pathology, Faculty of Medic University of Ljubljana,, Ljublijana, Slovenia
| | - Alessandro Franchi
- University of Florence, Dept of Surg & Translational Medicine University of Florence, Florence, Italy
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50
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Li W, Yu Y, Wang H, Yan A, Jiang X. Evaluation of the prognostic impact of postoperative adjuvant radiotherapy on head and neck mucosal melanoma: a meta-analysis. BMC Cancer 2015; 15:758. [PMID: 26490539 PMCID: PMC4618517 DOI: 10.1186/s12885-015-1750-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 10/09/2015] [Indexed: 02/03/2023] Open
Abstract
Background Head and neck mucosal melanoma (HNMM) is a rare type of malignant tumor that frequently exhibits postoperative recurrence and distant metastasis. Many clinicians administer postoperative adjuvant radiotherapy to improve patient prognosis and enhance quality of life; however, the effects of this treatment remain controversial. Therefore, in this study, a meta-analysis was performed to evaluate the practical value of postoperative adjuvant radiotherapy for head and neck mucosal melanoma. Methods Articles in the PubMed, MEDLINE, Cochrane Library, Web of Science and EMBASE databases were systematically retrieved. Analyses were conducted to compare the impact of treatments involving postoperative radiotherapy with treatments entailing surgery alone on patient overall survival time, local recurrence and distant metastasis. The hazard ratio (HR) was used to evaluate the time-to-event data employing RevMan version 5.2 and Stata/SE version 13.0 software according to the principles specified for systematic reviews of interventions in the Cochrane handbook. Results Twelve cohort studies involving 1593 patients satisfied the desired conditions. In comparing surgery alone with postoperative radiotherapy, there was no significant difference regarding a decrease in the death risk in HNMM patients (HR, 1.07; 95 % CI, 0.95–1.2; p = 0.903; low heterogeneity, I2 = 0); this was also the case for sinonasal melanoma after subgroup meta-analysis (HR, 1.04; 95 % CI, 0.8–1.36; p = 0.983; low heterogeneity, I2 = 0 %). A sensitivity analysis and subgroup meta-analysis showed that disease progression was the main source of the instability in the results. Surgery combined with postoperative radiotherapy reduced the risk of local recurrence (HR, 0.51; 95 % CI, 0.35–0.76; p = 0.155) but did not reduce the risk of distant metastasis (HR, 2.26; 95 % CI, 1.01–5.05; p = 0.006). Conclusions This study demonstrated that for HNMM patients surgery is recommended if indicated, and surgery combined with postoperative radiotherapy is also recommended for dramatically improved local control of the tumor bed. For patients not suitable for surgical treatment, radiotherapy is still advised. To control distant metastasis and finally lower the risk of death, immunological therapy is another potential option whose therapeutic effect needs to be proved with more data from clinical trials.
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Affiliation(s)
- Wei Li
- Department of Otorhinolaryngology, the First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
| | - Yalian Yu
- Department of Otorhinolaryngology, the First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
| | - Hailong Wang
- Department of Otorhinolaryngology, the First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
| | - Aihui Yan
- Department of Otorhinolaryngology, the First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
| | - Xuejun Jiang
- Department of Otorhinolaryngology, the First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
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