Head and neck mucosal malignant melanoma

Clinicopathologic correlation with contemporary review of prognostic indicators

Elizabeth H. Kerr, Omar Hameed, James S. Lewis, Alfred A. Bartolucci, Dezhi Wang, Nasser Said-Al-Naief

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Unlike their cutaneous counterparts, head and neck mucosal malignant melanomas (HNMM) behave much more aggressively and their prognostic markers have not been fully elucidated. Therefore, the aim of this study was to review the clinicopathologic features of a contemporary series of primary HNMM, retrieved from archival material of 2 large medical centers, and to explore the association, if any, between these variables, the clinical features, and outcomes. The clinicopathologic, radiographic, and follow-up information as well as the dominant histologic pattern, mitotic rate, presence/absence of pigmentation, necrosis, ulceration, vascular invasion, and host-associated lymphocytic response were retrieved and recorded. Twenty cases were identified including 1 melanoma in situ. Eight-five percent of tumors arose in the sinonasal tract and 3 (15%) in the oral cavity. After a median follow-up of 25 months, all patients with invasive melanoma developed recurrence and/or metastasis. Local recurrences occurred in 82% of the patients after a median of 12 months, and distant metastasis occurred in 71% of the patients after a median of 13 months. Of those with adequate follow-up, 82% died with disease, and the remaining 3 had recurrent or metastatic disease. Fourth-seven percent of tumors were pigmented, 89% showed at least focal necrosis, and 93% demonstrated ulceration. Sixth-eight percent showed vascular invasion and 63% had a brisk host lymphocytic response. Mitotic rates ranged from 2 to 60/10 high-power fields. The absence of an invasive component might be associated with a better prognosis but other clinical and pathological features that predict outcome, and/or could influence therapy, remain to be determined in HNMM.

Original languageEnglish (US)
Pages (from-to)37-46
Number of pages10
JournalInternational Journal of Surgical Pathology
Volume20
Issue number1
DOIs
StatePublished - Feb 2012
Externally publishedYes

Fingerprint

Melanoma
Neck
Head
Blood Vessels
Necrosis
Neoplasm Metastasis
Recurrence
Pigmentation
Mouth
Neoplasms
Skin
Therapeutics

Keywords

  • head and neck
  • melanoma
  • mucosal
  • oral cavity
  • sinonasal

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Head and neck mucosal malignant melanoma : Clinicopathologic correlation with contemporary review of prognostic indicators. / Kerr, Elizabeth H.; Hameed, Omar; Lewis, James S.; Bartolucci, Alfred A.; Wang, Dezhi; Said-Al-Naief, Nasser.

In: International Journal of Surgical Pathology, Vol. 20, No. 1, 02.2012, p. 37-46.

Research output: Contribution to journalArticle

Kerr, Elizabeth H. ; Hameed, Omar ; Lewis, James S. ; Bartolucci, Alfred A. ; Wang, Dezhi ; Said-Al-Naief, Nasser. / Head and neck mucosal malignant melanoma : Clinicopathologic correlation with contemporary review of prognostic indicators. In: International Journal of Surgical Pathology. 2012 ; Vol. 20, No. 1. pp. 37-46.
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abstract = "Unlike their cutaneous counterparts, head and neck mucosal malignant melanomas (HNMM) behave much more aggressively and their prognostic markers have not been fully elucidated. Therefore, the aim of this study was to review the clinicopathologic features of a contemporary series of primary HNMM, retrieved from archival material of 2 large medical centers, and to explore the association, if any, between these variables, the clinical features, and outcomes. The clinicopathologic, radiographic, and follow-up information as well as the dominant histologic pattern, mitotic rate, presence/absence of pigmentation, necrosis, ulceration, vascular invasion, and host-associated lymphocytic response were retrieved and recorded. Twenty cases were identified including 1 melanoma in situ. Eight-five percent of tumors arose in the sinonasal tract and 3 (15{\%}) in the oral cavity. After a median follow-up of 25 months, all patients with invasive melanoma developed recurrence and/or metastasis. Local recurrences occurred in 82{\%} of the patients after a median of 12 months, and distant metastasis occurred in 71{\%} of the patients after a median of 13 months. Of those with adequate follow-up, 82{\%} died with disease, and the remaining 3 had recurrent or metastatic disease. Fourth-seven percent of tumors were pigmented, 89{\%} showed at least focal necrosis, and 93{\%} demonstrated ulceration. Sixth-eight percent showed vascular invasion and 63{\%} had a brisk host lymphocytic response. Mitotic rates ranged from 2 to 60/10 high-power fields. The absence of an invasive component might be associated with a better prognosis but other clinical and pathological features that predict outcome, and/or could influence therapy, remain to be determined in HNMM.",
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