Primary mucosal melanoma of the larynx: systematic review of the literature and qualitative synthesis

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.

Role of ancillary techniques in profiling unclassified laryngeal malignancies

Laryngeal biopsies, contrary to biopsies from many other sites of the body, very often contain minute amounts of tumour tissue that may consist of morphologically undifferentiated tumour only. In haematoxylin- and eosin-stained sections, there may be no indicative features of what specific tumour entity that is present. In the larynx, particularly small round cell neoplasms, primary or metastatic, often cause a diagnostic dilemma and where an incorrect diagnosis can induce substantial clinical consequences for the patient (e.g., primary neuroendocrine carcinomas vs metastatic variants, certain sarcomas). If sufficient/representative material has been obtained, the application of immunohistochemistry and/or molecular techniques should in virtually every case reveal the true nature of the malignancy. In cases with sparse amount of material, and therefore a limited number of sections to be cut, a careful and thoughtful stepwise approach is necessary to ascertain a reliable diagnosis, or at least guide the clinician to the most likely diagnoses. With today's advanced and widely available technology with an abundance of markers to discriminate different tumours, the use of the term "undifferentiated" should be largely unnecessary. In the exceptional, and indeed exceedingly rare cases, when a classification is not possible, even after repeat biopsy, we suggest that the laryngeal neoplasm is better termed "unclassified malignant neoplasm" rather than "undifferentiated malignant neoplasm".

A case of primary subglottic malignant melanoma with a successful surgical treatment

Primary subglottic malignant melanoma is a very rare and underdiagnosed neoplasm. We are reporting a case of primary malignant melanoma of subglottic mucosa in a 78-year-old woman who presented to our hospital with shortness of breath and hoarseness of voice. Laryngoscopy and excisional biopsy along with immunoreactivity to S-100 and human melanoma black-45 (HMB-45) confirmed the diagnosis. The patient was treated with laryngectomy followed by radiotherapy. Five years following surgical treatment, she continues to be asymptomatic. To our knowledge, there is only one reported case of primary malignant melanoma of subglottic mucosa in the medical literatures.

[The presentation of laryngeal malignant tumors of mesenchymal origin]

Although laryngeal malignancies of mesenchymal origin (laryngeal sarcomas, LS) are extremely rare (1% of all laryngeal malignancies), the histological manifestations are very diverse. LS sign as a solid tumor covered with an intact mucosa.

THE AIM OF THE STUDY

was to evaluate retrospective data referring: epidemiology, clinical manifestations, treatment and early follow-up; based on medical record made in ORL, HNS Surgery Dpt of Holy Cross Cancer Centre in Kielce during 9-years period 2001-2009.

MATERIAL AND METHODS

The retrospective analysis of the group of 12 patients with LS was made. Studied characteristics were: age, sex, primary focus, histological outcome, treatment options and early follow-up.

RESULTS

Age of the group of 12 studied patients (10 M, 2 F) ranged from 48 to 84 (mean 69.8). LS accounted 1.2% (12/935) for all of laryngeal malignancies. The focus of origin were: glottis (6), epiglottis (5); subglottis (1). The most common histological types of LS at studied group were: neurosarcoma (2), fibrosarcoma (2), plasmocytoma (2), chondrosarcoma (1), malignant fibrous histiocytoma (1), sarcoma low grade (1), lymphoma malignum (1), liposarcoma (1) and haemangioendothelioma epithelioides vel plasmocytoma (1). Methods of treatment were: surgery (6); radiotherapy (1); chemotherapy (1); chemo- and radiotherapy (3); symptomatic treatment (1). The clinical results of treatment are: 9 patients are still alive (5 pts more than 5 years, 3 pts less than 5 years, 1 pts less than 2.5 years with residual disease); 3 patient died: 2 pts in 1st year from diagnosis, 1 pts after 3 years of treatment died of non-oncological causes.

CONCLUSIONS

1. LS are extremely rare and diversed histologically. 2. Immunochemical analyses are very important procedures used in diagnostics of these malignancies. 3. An individual approach is needed in diagnostic and therapeutic procedures of LS.

[Acute dyspnea in malignant melanoma]

Metastases to the larynx are rare. The current article presents the case of a 75-year-old patient with a history of shortness of breath due to a supraglottic exophytic lesion that was identified as a metastasis of a cutaneous melanoma treated 2.5 years previously. As a result of our medline analysis we found approximately 30 cases of metastatic melanoma to the larynx published to date. Primary tumors are always cutaneous in origin and spread over the whole integument of trunk and extremities. The time interval between diagnosis of the primary and the laryngeal metastasis is often several years. In most reports a supraglottic exophytic, red coloured lesion is described. Diagnosis can only be proven by histological examination. Laryngeal metastasis is usually an indication of tumor dissemination and always has a fatal prognosis.