JAMA Otol Logo Orlando 2013 AHNS Meeting Location
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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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PRESENTATION AND OUTCOME OF MELANOMA ARISING FROM THE MUCOUS MEMBRANES OF HEAD AND NECK IN COMPARISON TO OTHER MUCOSAL MELANOMAS AND CUTANEOUS MELANOMA: A SURVEILLANCE EPIDEMIOLOGY AND END RESULTS (SEER) DATABASE REVIEW

Presentation: P047
Topic: Clinical - Gen. Head & Neck Surgery
Type: Poster
Date: Wednesday - Thursday, April 10 - 11, 2013
Session: Designated Poster viewing times
Authors: Anteneh Tesfaye, MD, Ioana Morariu, MD, Radhika Kakarala, MD, David Eilender, MD, Sunil Nagpal, MD
Institution(s): McLaren Healthcare-Flint/Michigan State University

Introduction:
Mucosal melanoma is a rare subtype of melanoma, with limited clinical experience. Different smaller sized reports have indicated that this form of melanoma has dismal prognosis compared to cutaneous melanoma. A study was undertaken to describe the presentation and outcome of mucosal melanoma arising from head and neck in comparison to other mucosal sites and the skin using the SEER database.

Methods:
The 1973-2009 Surveillance, Epidemiology, and End results (SEER) database was reviewed for cutaneous and mucosal melanoma between 2004 -2009. Patients with eye and orbital melanoma or additional primary malignancy were excluded from the study. Age, race, gender, location of the melanoma, histology, SEER summary of stage, TNM staging, survival time, cause specific death classification and vital status were extracted from the database.

Results:
A total of 72,900 cases of melanoma meeting criteria were identified between 2004 and 2009 from the 1973-2009 SEER database. Mucosal melanoma of the head and neck contributed to 289 (0.4%) cases, while other mucosal melanomas (Gastrointestinal and Genitourinary) and the skin contributed to 559 (0.8%) and 72052 (98.8%) cases of melanoma respectively. The mean age at presentation for mucosal melanoma of the head and neck was 68 years compared to 67 in other mucosal melanomas and 57 in patients with cutaneous melanoma, p=0.004. The proportion of females in mucosal melanoma of the head and neck was 53.6%, compared to 77.3% in other mucosal melanomas and 45.4% in the skin, p=0.0000. The proportion of ethnic minorities in the group with mucosal melanoma of head and neck was 11.5% compared to other mucosal melanomas (15.6%) and cutaneous melanoma (1.4%), p=0.0000. The majority (76.5%) of mucosal melanoma of the head and neck were in the sinonasal tract compared to the oropharyngeal structures (23.5%). Higher proportion (65.7%) of patients with mucosal melanoma of the head and neck presented with regional or metastatic disease compared to 48.1% in other mucosal melanomas and 12.7% in the skin, p=0.0000. Upon stage-to-stage comparison, mucosal melanoma had far more worse survival than cutaneous melanoma in local and regional stages, but not in metastatic disease (See table 2). Cox proportional hazard model showed that patients with mucosal melanoma had 122% higher odds of dying of their disease compared to patients with cutaneous melanoma (HR (95% CI) = 2.22 (1.979 - 2.489); p=0.000).

Discussion:
Mucosal melanoma is a rare form of melanoma. Melanoma arising from head and neck mucous membranes accounted for a third of all mucosal melanomas. Sinonasal tract was the commonest site of mucosal melanoma in the head and neck. Two thirds of cases of mucosal melanoma in the head and neck present with advanced staging, unlike cutaneous melanoma which was diagnosed in local stage in more than 85% of the cases. Anorectal mucosal melanoma has the worst 5 year cancer specific survival among all mucosal melanomas. Patients with localized and regional mucosal melanoma had far more worse prognosis compared to similarly staged cutaneous melanoma. But there was no significant survival difference between metastatic mucosal and cutaneous melanomas. 

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