Primary mucosal melanoma of head and neck: Prognostic value of clear margins

Background: Primary mucosal melanomas of the head and neck (NEMEHN) are rare and carry a poor outcome. The impact of different treatments on survival is not yet clearly established. Methods: Twenty patients treated from 1991 to 2004 at a single referral center were retrospectively reviewed. Results: Primary sites were oral mucosa in 14 cases, paranasal sinuses in three cases, and nasal cavities in three cases. The sex ratio was equal to 1, and the median age at diagnosis was 63 years (range, 17-77 y). At presentation, one patient had lymph node metastases, one patient had distant metastases, and one patient had both. Surgery was performed with curative intent in 19 cases (and achieved clear margins in 14 cases). Postoperative radiation therapy was delivered in four cases. The actuarial 2-year and 5-year survival rates were 13/19 and 7/16. The risk factors for death were male gender (RR = 9.3 [1.2-72], P =.024) and positive margins (RR = 21 [1.9-47], P =.013). In addition, we observed three metachromous cancers (one breast cancer, one kidney cancer and one lymphoma) during the follow-up period. Conclusion: The present study suggests that obtaining clear margins must be the goal in the treatment of MMNH.