Head and neck mucosal melanoma (part II): surgical and systemic treatment, therapy outcomes and prognostic factors.

Surgery, with an attempt to remove a tumor within a margin of healthy tissues, is the preferred primary treatment of head and neck mucosal melanoma (HNMM). Despite radical surgery, the tumor tends to recur locally and give regional or distant metastases in many patients. Classical radical surgery is usually applied for sinonasal mucosal melanoma. Endoscopy is an alternative to classical surgery, but can be used in specific clinical cases and when appropriate criteria are met. The basic treatment method in patients with oral mucosal melanoma is ablation of various degrees depending on tumor location and local advancement. The presence of metastases from HNMM in the regional lymph nodes is an indication to lymphadenectomy. Experts from the National Comprehensive Cancer Network emphasize the role of prophylactic lymphadenectomy in oral mucosal melanoma but see no reason for its application in sinonasal mucosal melanoma. HNMM patients have not been and still are not frequently included in clinical trials investigating cutaneous melanoma. Adjuvant systemic treatment of patients operated for HNMM raises many doubts. Patients with a generalized disease and/or inoperable locally advanced tumor frequently receive systemic treatment similar to that applied for cutaneous melanoma. However, a different clinical picture, histopathological features and significant molecular differences suggest that a different systemic treatment would be more adequate. To date, none systemic therapy has been found effective in this group of patients. New drugs for molecular targeted therapy (vemurafenib, dabrafenib, imatinib) and immunotherapy (ipilimumab, pembrolizumab, nivolumab) are promising in terms of effective treatment of patients with generalized and/or inoperable HNMM. Therapy outcomes are poor and much worse when compared to cutaneous melanoma patients. Five-year overall survival ranges from 20% to 40%. [ABSTRACT FROM AUTHOR]