Experience with mucosal melanoma of the nose and paranasal sinuses.

PURPOSE: Sinonasal mucosal melanoma is a rare and aggressive disease and its incidence does not mimic that of its cutaneous counterpart in the Australian population. The present study examines one unit's experience with the disease and proposes a treatment strategy. The significance of macroscopic widespread mucosal melanosis and histological melanoma in situ is considered in the present study to be crucial in overall survival and the main cause of local failure and is specifically addressed. METHODS: The present study represents the retrospective experience of the multidisciplinary Head and Neck Clinic at the Prince of Wales Hospital over a 30-years period (from 1970 to end 1999) in the management of the disease, including both primary and salvage treatment approaches. The study includes 27 patients treated with surgery with or without postoperative radiation therapy. Management of recurrence was also considered. RESULTS: The mean time to local recurrence was 14.7 months and the mean time to distant metastases was 23.2 months. Mean survival time was 52 months and mean time from local recurrence to death was 75 months. Overall, disease free and disease specific survival and survival post-recurrence were analysed by the Kaplan-Meir method. A cancer specific 5 years survival of 46% was achieved, which compares favourably with recent international series. CONCLUSION: Sinonasal mucosal melanoma remains an aggressive disease with the possibility of local recurrence years after initial treatment, however, initial radical surgery encompassing the primary lesion and distant in situ or satellite disease and postoperative radiotherapy can offer long-term control, as can reoperation for local recurrence where appropriate.

Salvage nasopharyngectomy for radiation recurrences.

BACKGROUND: Salvage nasopharyngectomy has proven to be worthwhile in the management of persistent or recurrent nasopharyngeal cancer after radiotherapy failure; however, surgical complications are common and the indications for surgery and the choice of operation remain controversial. METHODS: Over a 17-year period from 1985 to 2001 salvage nasopharyngectomy was undertaken on 11 patients. In six patients an anterolateral disassembly approach was employed and five patients were treated with the more limited maxillary swing approach. In seven patients the nasopharynx was reconstructed with a revascularized forearm free graft. RESULTS: Six patients remain alive and free of disease with a minimum follow up of 4 years. There were no incidences of serious postoperative complications. The five patients who failed all did so locally. CONCLUSIONS: Nasopharyngectomy is safe and effective in the treatment of recurrent nasopharyngeal cancer even after multiple courses of radiotherapy.