Sinonasal Malignant Melanomas (SNMM): A Clinicopathologic Review of 17 Cases
EH Kerr, O Hameed, A Bartolucci, JS Lewis, Jr, N Said-Al-Naief. University of Alabama at Birmingham, Birmingham, AL; Washington University, St. Louis, MO; University of the Pacific, San Francisco, CA
Background: Primary SNMM is rare compromising <4% of sinonasal tumors. Given its rarity, the literature is limited to case reports and a few clinical series. The aim of this study was to review the clinicopathological features of a contemporary series of primary SNMM.
Design: A retrospective search was performed to identify cases of primary SNMM at two university medical centers. Clinical, radiographic, and follow up information was obtained from medical records. Histological sections were reviewed by two investigators to determine the dominant histologic pattern, mitotic rate, and the presence/absence of pigmentation, necrosis, ulceration, vascular invasion, and host-associated lymphocytic response. The findings were correlated with follow up information.
Results: Between June 1993 and January 2008, 17 cases were identified including 1 melanoma in situ. There were 10 men and 7 women, 52 to 88 years of age (mean, 70). The tumor was limited to the nasal cavity in 11 patients (65%), and 2 patients each showed involvement of the maxillary sinuses, ethmoid sinuses, and skull base. The invasive melanomas displayed a spindle, plasmacytoid, epitheloid, or a small blue round cell morphology in 6 (38%), 5 (31%), 4 (25%) and 1 (6%) cases, respectively. Eight (50%) cases were non-pigmented; 15 (94%) showed at least focal necrosis and 11 (69%) each showed ulceration, vascular invasion or host lymphocytic response. Mitotic rate ranged from 2 to 60/10 HPFs (mean, 20; median, 14). One patient died in the immediate postoperative period. After a median follow up of 17 mo (range, 4 to 117 mo), all patients with invasive melanoma developed recurrences and/or metastasis. Local recurrences developed in 13 patients after a median of 10 mo (range, 1 to 105 mo) and distant metastasis developed in 10 patients after a median of 12 mo (range, 1 to 36 mo). Twelve patients died with disease after a median of 16 mo (range, 4 to 117 mo). None of the evaluated clinical or histological findings were associated with a particular outcome.
Conclusions: SNMM are morphologically quite variable, often non-pigmented and are associated with an aggressive course whereby almost all patients develop recurrences and/or metastases often within a short period. Although the absence of an invasive component might be associated with a better outcome, clinical and pathological features that may predict outcome, and/or could influence therapy, remain to be determined.
Category: Head & Neck
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 164, Wednesday Morning