Clinical and molecular analysis of sinunasal melanomas

Sinunasal melanoma (SNM) is a rare and aggressive disease with a 5-year survival rate of 25 %. The therapy standard is surgery with adjuvant radiotherapy. However, immune checkpoint inhibitors (ICIs) are increasingly used in the treatment of SNM.

From 2004 to 2018, 37 patients were treated with SNM at the Würzburg ENT University Hospital. The demographic data were collected. A tumor mutation analysis was performed for 57 % of the patients. Tumor survival was determined and compared using the log-rank test.

The mean age at diagnosis was 72 years. 36 % were male and 64 % female. The most common first symptoms were epistaxis, nasal obstruction, nasal discharge and pain. The genetic analysis revealed one BRAF, no c-Kit, one KRAS, and three NRAS mutations. Surgical resection was the most common therapy with 89 %, followed by primary radiotherapy with 19 %. A total of 30 patients had a relapse or residual tumor. Of these, 10 were local, 4 regional and 10 distant recurrences. Eight patients received ICI therapy. This resulted in complete remission in two patients.

The 5-year survival rate was 23 %. In this cohort, tumor stages, resection status, and adjuvant radiotherapy did not influence overall survival.

SNM are underrepresented in melanoma studies due to their rarity. This makes an interdisciplinary treatment strategy even more appropriate. ICIs represent a promising therapeutic approach and could be integrated as a potential standard medication in the treatment of SNM.

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Publication History

Article published online:
10 June 2020