Metastatic melanoma to the upper aerodigestive tract

Mifsud, Matthew; Padhya, Tapan

doi:10.1002/lary.24436

Cited by 18 publications

(18 citation statements)

References 59 publications

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“…Treatments with approriate aggressive multimodal therapies are needed in such cases (metastectomy, segmental resection, laser excision, external beam radiation). [98][99][100] In conclusions, findings are suggestive that pulmonary metastectomy for carefully selected patients warrant a favourable outcome.…”

Section: Surgery Of Pulmonary Metastases (Stage IV M1b)mentioning

confidence: 99%

Surgery and Staging of Melanoma

Gyulai¹,

Kádár²,

Lengyel³

2015

Melanoma - Current Clinical Management and Future Therapeutics

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Early diagnosis and complete removal of the malignant cells are of paramount importance in the treatment of malignant melanoma. This usually requires a two-step approach. First, pigmented or amelanotic lesions suspicious for melanoma should be promptly biopsied and submitted to pathological evaluation, and second, the tumor should be subsequently excised with adequate surgical margins. The margins of the final excision are determined with the tumor characteristics in mind, as determined by the histopathological analysis of the biopsy specimen. Thus, removal of appropriate biopsy sample containing the fragment with the worst prognostic characteristics, is of substantial importance. As extensive loss of tissues may potentially influence the feasibility of further surgical interventions, such as the sentinel lymph node biopsy, the use of proper biopsy techniques is essential during the primary treatment of melanoma. Recommendations regarding the width of the surgical margin of excision are nowadays clearly defined for primary melanoma, and are based on the histopathological features of the melanoma. These recommendations, however, are sometimes difficult or impossible to follow, like in the case of specially localized melanomas, or certain melanoma subtypes. This chapter summarizes the available evidence regarding different biopsy techniques and the surgical management of primary melanoma. 2.1. Biopsy of melanoma suspect lesions The primary aim of performing biopsy in the case of a melanoma suspect lesion is to establish or exclude the diagnosis of melanoma. An additional goal is to ensure accurate pathological staging of the tumor in order to enable adequate surgical management by performing wide local excision (WLE). Excisional, incisional and shave biopsy techniques are used in the surgical treatment of melanoma. 2.1.1. Excisional biopsy The preferred biopsy technique for most melanomas is excisional biopsy.[1,2] This means that the entire lesion is removed with an additional 1-3 mm margin of normal-appearing skin. Wider excisions, however, should be avoided, to permit subsequent lymphatic mapping for sentinel lymph node biopsy. Generally, the excised tissue sample should contain part of the subcutaneous fat as well, and should be oriented to aid subsequent histopathological evaluation. The positioning of the excision also should possibly allow for subsequent wider excisions. The excisional biopsy technique can be used in most melanomas, when primary closure of the wound is feasible. Although the lowest frequency of positive margins is reported when excisional biopsy is used, positive margins and even residual melanoma on WLE do occur.[3] 2.1.2. Incisional biopsy The reported frequency of excisional biopsy technique used for diagnosing melanoma varies significantly with centers, countries, and individuals, and ranges between 10 and 86 percent.

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Section: Surgery Of Pulmonary Metastases (Stage IV M1b)mentioning

confidence: 99%

Surgery and Staging of Melanoma

Gyulai¹,

Kádár²,

Lengyel³

2015

Melanoma - Current Clinical Management and Future Therapeutics

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“…3,14 Even though no treatment modality for tonsillar metastasis from melanoma has been proven to be effective, a combination of tonsillectomy and immunotherapy prolonged a patient's survival to Barton, BM 52 months after the initial metastatic presentation. 11,15 Once metastatic melanoma is found on the palatine tonsil, the condition is assumed to have disseminated to other viscera; hence, patients and family should be introduced to hospice and palliative care early.…”

Section: Discussionmentioning

confidence: 99%

Delayed Metastatic Melanoma to the Pharyngeal Tonsil in an African American Female

Barton

Ramsey

Magne

et al. 2018

TOJ

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Background: Metastatic melanoma to the mucosa of the upper aerodigestive tract is extremely rare, accounting for <0.6% of known metastasis to the head and neck region. We present a case of delayed metastatic melanoma to the pharyngeal tonsil. Case Report: A 57-year-old African American female presented for evaluation of a rapidly enlarging unilateral tonsil mass. Three years prior to presentation, she had undergone primary resection of and systemic therapy for cutaneous melanoma on the sole of her right foot. Tonsillectomy confirmed the diagnosis of metastatic melanoma. Because of the poor prognosis of the disease, the patient was referred for palliative chemotherapy but died shortly after beginning treatment. Conclusion: Metastatic melanoma is a rare disease in African Americans, and the presence of metastatic lesions is a significant prognostic indicator for long-term patient survival. Meticulous head and neck examinations should be performed during the follow-up period, and any pigmented lesion should have a high suspicion for metastasis in any patient with a history of cutaneous melanoma.

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“…Only 0.6% to 9.3% of patients with cutaneous melanoma will develop metastases in the mucosa of the upper aerodigestive tract. There are few discussions in the literature about this condition [ 3 , 4 , 6 , 7 ]. Metastases of melanoma to head and neck mucosa, including the oral cavity, are very rare [ 3 , 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the oral cavity, almost 80% of all primary melanomas occur in the keratinized mucosa of the hard palate, followed by maxillary and mandibular, and buccal mucosa [ 1 ]. Metastatic melanomas of the head and neck mucosa have been found most often in the oropharynx, larynx, oral cavity, nasopharynx, tonsil and lip [ 3 , 4 , 7 ]. Our study reports two cases of metastatic melanoma in uncommon sites of the oral cavity (floor of mouth and gingival mucosa), one case in the oropharynx and another in the larynx.…”

Section: Discussionmentioning

confidence: 99%

“…In spite of most patients usually presenting several metastatic tumors at diagnosis, these lesions may represent a diagnostic challenge. There are very few previously published studies with series of cases of metastases of the melanoma to the head and neck mucosa [ 3 - 7 ]. Thus, the aim of this study was to report 4 cases of metastatic melanoma to the mucosal surfaces of the head and neck.…”

Section: Introductionmentioning

confidence: 99%

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Metastases of Melanoma to Head and Neck Mucosa: A Report of Short Series

Santos

Andrade

Alves

et al. 2016

Clin Exp Otorhinolaryngol

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ObjectivesMetastasis of melanoma to the head and neck mucosa is a very unusual condition. The aim of this study was to report four cases of patients with metastatic melanoma in the head and neck mucosa treated at a single institution.MethodsClinical data were obtained from the medical records. All cases were histologically reviewed to confirm the diagnosis, and immunohistochemical reactions were performed in the cases submitted to biopsy. ResultsAll patients were males and the mean age was 40.5 years old. The sites of the metastatic tumors were gingival mucosa, floor of the mouth, oropharynx, and larynx. Two tumors appeared as submucosal nodules with normal color; one lesion was a blackish nodular lesion, and one was shown to be an ulcerated lesion. The size of tumors ranged from 2.0 to 4.0 cm. All patients had developed systemic disease at time of diagnosis of metastatic tumor in the head and neck mucosa. Survival rates ranged from 2 to 19 months after the diagnosis of the metastatic mucosal melanoma in the head and neck region.ConclusionAlthough rare, patients with melanoma must be closely and regularly followed up, with careful routine examination of head and neck, because metastatic tumors in this region seem to be part of a lethal widespread metastatic disease.

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Metastatic melanoma to the upper aerodigestive tract

Cited by 18 publications

References 59 publications

Surgery and Staging of Melanoma

Surgery and Staging of Melanoma

Delayed Metastatic Melanoma to the Pharyngeal Tonsil in an African American Female

Metastases of Melanoma to Head and Neck Mucosa: A Report of Short Series

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