Primary melanoma of the petrous temporal bone

A Systematic Review of Primary Temporal Bone Mucosal Melanoma

OBJECTIVE

Temporal bone mucosal melanomas (MMs) are rare, and patients may experience delays in diagnosis and treatment. Our objective was to better characterize the presentation, diagnosis, treatment modalities, and outcomes of this process.

DATA SOURCES

PubMed/Medline, CINAHL (EBSCOhost), and Web of Science databases were searched in all languages without restriction of publication dates.

STUDY SELECTION

Inclusion criteria included that the article was either a case report or a case series with individual case data. All non-English articles were excluded if the corresponding abstract lacked data on demographics, initial presentation, and clinical management.

DATA EXTRACTION

After full-text analysis, data pertaining to demographics, diagnosis, medical and surgical management modalities, and outcomes were extracted.

DATA SYNTHESIS

Data were qualitatively synthesized, and means and averages were obtained for all continuous variables. Overall survival was measured by the Kaplan-Meier method, and significance was measured through log-rank testing.

CONCLUSIONS

Clinicians should suspect temporal bone MM in the differential diagnosis of patients with bloody otorrhea in the context of a chronic serous otitis media or an associated cranial nerve palsy. If suspected, physicians should not delay the acquisition of a biopsy or imaging studies. Management is highly variable and must be decided on a case-by-case basis. Outcomes remain poor because of the high propensity for MM to metastasize.

Treatment, Survival, and Demographics in Temporal Bone Malignancies: A Pooled Data Analysis

Temporal bone malignancies are relatively uncommon tumors. Their location adjacent to vital structures such as the carotid artery, jugular vein, otic capsule, and temporal lobe can make their treatment potentially challenging. The purpose of this study was to compare outcomes in temporal bone malignancies obtained via pooled literature data. The study sought to examine factors affecting survival in temporal bone malignancies based on the studies in the existing published literature. A systematic search was conducted on the PubMed (Medline), Embase, and Google Scholar databases to identify relevant studies from 1951 to 2022 that described the treatment of temporal bone malignancies. Articles that fulfilled the inclusion criteria were assessed and analyzed by the author. The literature search identified 5875 case series and case reports, and 161 of them contained sufficient data to be included in the pooled data analysis, involving a total of 825 patients. Multivariate analysis of the pooled literature data showed that overall stage, presence of facial palsy, and surgical margin status significantly affected overall survival (OS), while overall stage and presence of facial palsy significantly affected disease-free survival (DFS). To summarize, this study examined pooled survival data on demographics, treatment, and survival of patients with temporal bone malignancies utilizing an extensive literature-based pooled data meta-analysis. Overall stage, facial nerve status, and surgical margin status appeared to most strongly affect survival in patients with temporal bone malignancies.

Remission of Mucosal Melanoma of the Middle Ear and Petrous Temporal Bone and Reversal of Cranial Nerve Paresis Following Radiation and Single Agent Nivolumab: Clinical Capsule and Review of the Literature

OBJECTIVE

We report disease remission and recovery of fifth and seventh nerve paresis in a case of primary mucosal melanoma of the middle ear and petrous temporal bone.

PATIENT

A 74-year-old man developed sudden, profound, right sided sensorineural hearing loss, disequilibrium, otalgia, and cranial nerve V and VII dysfunction. Imaging demonstrated an unresectable, osteolytic lesion involving the middle ear and anterior petrous apex. Melanoma was diagnosed via in-office biopsy; whole-body metabolic imaging revealed no other primary site.

INTERVENTION

Multidisciplinary management included radiation therapy (30 Gy, 10 fractions) followed by induction (five cycles, q2w) and maintenance nivolumab (six cycles, q3w).

MAIN OUTCOME MEASURE

Complete metabolic response of primary site and metastases on imaging, recovery of cranial neuropathies.

RESULTS

Following palliative radiation therapy and induction nivolumab, cranial neuropathies resolved. With maintenance-dose nivolumab, primary site and metastases exhibited a complete response. Therapy was stopped at 16 months post-diagnosis. Complete remission was maintained until 22 months after diagnosis. The patient developed a solitary cerebral metastasis which was refractory to radiosurgery and biopsy confirmed melanoma. He expired 2 years, 8 months post-diagnosis.

CONCLUSIONS

Mucosal melanoma of the middle ear and petrous temporal bone is exceedingly rare. Management is individualized and surgery is undertaken when possible. Key observations in this case are the complete metabolic response and reversal of cranial nerve neuropathies following radiation and anti-programed cell death receptor ligand 1 therapy. Non-surgical treatment is worthy of study as initial management for similar lesions.