Prognostic factors in 161 patients with mucosal melanoma: a study of German Central Malignant Melanoma Registry

Abstract

Background Mucosal melanoma is a rare malignancy which represents approximately 1% of all melanomas. It is shown that mucosal melanomas have a different biology and less favourable prognosis than its cutaneous counterpart. Objectives Predictive and prognostic factors of survival for mucosal melanoma have not yet been elucidated. The aim of this study was to investigate risk factors affecting the course of mucosal melanoma patients followed in our clinic. Methods One hundred and sixty‐one patients with mucosal melanoma prospectively documented in the German Central Malignant Melanoma Registry (CMMR) were included in this study. Gender, age, localization, stage at first medical examination, tumour thickness and mutational status were documented. The American Joint Committee on Cancer (AJCC), 7th edition was used to define tumour stage. Kaplan–Meier survival curves were evaluated compared with the log‐rank test. Multivariate Cox proportional hazard models were used to identify significant independent prognostic factors. Results According to the localization, patients were categorized in 44.7% oral–nasal, 28.6% genital, 20.5% anorectal and 6.2% visceral. Genital mucosal melanomas had the most favourable 5‐year OS rate (58.6%) followed by visceral (58.3%) and oral–nasal (39.3%). Anorectal melanomas had the worst OS time (median: 21 ± 4.8 months) and 5‐year survival rate (22.7%). Patients <60 years had a better survival than the older group (P = 0.013). Tumour stage at the time of the first medical examination was also a significant factor for survival (P = 0.001). Gender and mutational status were found to have no effect on survival. Age (<60 years vs. ≥60 years; HR = 2.1) and stage at first medical examination (Stage I vs. Stage IV; HR = 8.2) are shown to be significant independent prognostic factors on multivariate Cox regression analysis, but not localization. Conclusion In this study, we observed that older age and advanced stage have significant negative effects on the survival of mucosal melanoma. Thus, the AJCC staging system is applicable for mucosal melanoma.

Anorectal Melanoma

“…On multivariate analysis, younger age, urban location of the patients and surgery were associated with better OS [52]. Other studies have found that age, tumor thickness, presence of ulceration, lymphovascular invasion, perineural invasion and tumor AJCC stage are the main predictors of survival [15,39,40].…”

“…The 5-year survival rate of colorectal melanoma ranges from 4.3% to 17.4% [73]. The median survival of AM has been reported as 21 months [95% CI: 11-30] [15]. The 5-year OS rates of Stage I, II and III are 26.7%, 9.8% and 0% respectively [35].…”

Prognostic Roles of BRAF, KIT, NRAS, IGF2R and SF3B1 Mutations in Mucosal Melanomas

“…The poor prognosis is likely a result of delay in diagnosis due to anatomic location. Overall survival (OS) has been cited to be highest in the vulvovaginal melanoma group, followed by sinonasal melanoma, and then anorectal melanoma [ 4 , 8 , 20 ]. Similar to findings reported in a series of 706 mucosal melanomas by Cui et al [ 6 ], no significant correlation between survival and anatomic sites is observed in our study.…”

“…In line with prognosis, genetic alterations occurring in mucosal melanoma are different than those of cutaneous wild-type melanoma ( BRAF , NRAS and NF1 negative) [ 2 , 3 ]. The frequency of frequently mutated genes are as follows: NRAS (14–30%), BRAF (5–16%), NF1 (16%), KIT (5–15%), SF3B1 (12%), TP53 (8.9%), SPRED1 (7%), ATRX (6%) and CHD8 (4%) [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Recently, IGF2R mutation was documented in 32% of 41 mucosal melanomas in comparison to 6% of 48 cutaneous melanomas [ 10 ].…”

Perspectives on the use and risk of adverse events associated with cytokine-storm targeting antibodies and challenges associated with development of novel monoclonal antibodies for the treatment of COVID-19 clinical cases

“… 45 , 46 Early reports of pervasive mortalities in elderly patients with comorbidities (8 out of 10) such as diabetes and heart and lung diseases underscored the apparent vulnerability of elderly individuals. 47 , 48 Other clinically significant comorbidities include but are not limited to chronic lung disease or moderate-to-severe asthma; serious heart conditions; immunosuppression, including cases of poorly controlled human immunodeficiency virus (HIV) or AIDS; prolonged use of corticosteroids; and severe obesity (body mass index ≥40). 49 During the course of the ongoing pandemic, several studies have focused on cohorts of COVID-19 patients who died from severe pneumonia.…”