Objectives. Mucosal melanomas are rarer than their cutaneous counterparts and are associated with a poorer prognosis. We report the clinical outcomes of patients with mucosal melanomas of the head and neck region generally treated with definitive surgery followed by postoperative radiation therapy (RT). Methods. We reviewed the records of 17 patients treated at the University of Miami in 1990–2007. Patients generally received conventionally fractionated RT regimens to the postoperative bed. Elective nodal RT was not routinely delivered. Eight patients received adjuvant chemotherapy or immunotherapy. Results. Median followup was 35.2 months (range 5–225). As the first site of failure: 3 patients recurred locally, 2 regionally and 2 distantly. All 3 patients who recurred locally had not received RT. Of the 5 locoregional recurrences, 4 were salvaged successfully with multimodality therapy with no evidence of disease at last followup. Overall survival was 64.7% at 2 years and 51.5% at 5 years. Conclusions. Patients with mucosal melanoma of the head and neck are best treated with surgery to achieve negative margins, followed by postoperative RT to optimize local control. Elective nodal irradiation may not be indicated in all cases, as regional failures were not predominant. Distant metastases were fewer when compared to historical data, potentially due to advancements in adjuvant therapies as well as aggressive multi-modality salvage at time of failure. 1. Introduction Mucosal melanomas are exceedingly rare tumors which comprise a small subset of all melanomas but are associated with an even poorer prognosis than their cutaneous counterparts [1]. While mucosal primaries account for less than 2% of all melanomas in the United States, approximately 50% of mucosal melanomas occurs in the head and neck region [2]. These lesions most commonly present in the oral cavity, nasal cavity, or paranasal sinuses, all of which are lined with ectodermal derived mucosa. Other head and neck sites such as the pharynx and larynx are endodermal in their origin and therefore are rarely affected [3]. Despite their rarity, the aggressive nature of these tumors has been well established, with 5-year overall survival rates generally described as 30% at best [3–5]. The poor prognosis is typically associated with early presentation of distant metastases despite adequate locoregional control [1]. As these lesions are uncommonly encountered, there remains a paucity of data to clearly delineate optimal treatment regimens. Primary treatment has typically consisted of surgery and/or
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