Mucosal Melanoma: A Rare Entity and Review of the Literature

Abstract

Mucosal melanoma is a rare variant of melanoma representing around 1% of total cases of melanoma diagnosed. The usual sites of mucosal involvement are the sino-nasal passages, the oral cavity, and less commonly the upper gastrointestinal (GI) tract. It also has been reported to occur in vulvovaginal and anorectal mucosa. We present a rare case of mucosal melanoma that presented as recurrent epistaxis, headache, and sinus pressure. CT maxillofacial imaging revealed a large mass right nasal cavity. This was biopsied by ENT and shown to be mucosal melanoma. This was treated with palliative radiation followed by immunotherapy with nivolumab. Along with details of the case, we also discuss current treatment options with a focus on the role of immunotherapy and its efficacy in cases of head and neck mucosal melanoma. Our review of literature supports use of combination immunotherapy (including both nivolumab and ipilimumab) as it shows greater efficacy than either therapy alone. When combined with radiation therapy (RT) the overall response rate is improved and RT induces an abscopal effect; where benefits of RT are also seen at nonirradiated locations. In our patient, the use of radiation was essentially palliative as the patient was deemed to not be a surgical candidate. We discuss in our literature review the optimum timing of radiation in relation to definitive surgery or immunotherapy.

Fates of Au, Ag, ZnO, and CeO2Nanoparticles in Simulated Gastric Fluid Studied using Single-Particle-Inductively Coupled Plasma-Mass Spectrometry

“…These applications could directly increase human exposure to ENPs. [3][4][5][6] Many studies imply that exposure to ENPs is strongly correlated to some pathophysiological mechanisms. [7][8][9] The toxicity of nanoparticles is determined by various factors, such as size, concentration, shape, stability, and agglomeration.…”

Prognostic Value of Tumor‐Infiltrating Lymphocytes in Sinonasal Mucosal Melanoma

“…9,11 Radical surgical resection with a wide safety margin is considered the treatment of choice in the non-metastatic stage. 9,14 Due to the multilocularity of the tumor and its proximity to vital structures like the carotid artery and the brain, complete resection with adequate safety margins is often difficult or impossible or may require mutilating procedures such as (partial) removal of the external nose or eye. Frequently, numerous recurrent procedures become necessary as the disease progresses.…”

“…In addition to the mutation status of the oncogenes BRAF, NRAS, and KIT, the therapy is based on individual patient characteristics. 5,11,14,43 Late-line therapies also include platinum-based chemotherapies. [43][44][45] Currently available treatment regimens vary considerably with regard to side effects and efficacy and often require compromises between cancer control and therapy-associated morbidity.…”

“…11 There is also a lack of histopathologic assessment standards and established, evidence-based therapeutic guidelines. [11][12][13][14] The selection of the appropriate therapeutic and follow-up strategy is a major challenge, especially in view of the usually fatal course of the disease. The identification of reliable prognostic factors could significantly facilitate individual treatment planning.…”

“…To date, little is known about the risk factors, pathogenesis, and prognostic factors of SNMM 11 . There is also a lack of histopathologic assessment standards and established, evidence‐based therapeutic guidelines 11–14 . The selection of the appropriate therapeutic and follow‐up strategy is a major challenge, especially in view of the usually fatal course of the disease.…”