Association of Surgical Approach and Margin Status With Oncologic Outcomes Following Gross Total Resection for Sinonasal Melanoma | Dermatology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
From the American Head and Neck Society
December 2017

Association of Surgical Approach and Margin Status With Oncologic Outcomes Following Gross Total Resection for Sinonasal Melanoma

Author Affiliations
  • 1Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
  • 3Neurosurgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Otolaryngol Head Neck Surg. 2017;143(12):1220-1227. doi:10.1001/jamaoto.2017.2011
Key Points

Question  What is the association of operative approach and margin status with oncologic outcomes following gross total resection of sinonasal mucosal melanoma?

Findings  In this cohort study of 72 patients with nonmetastatic sinonasal mucosal melanoma, no differences in overall survival in patients undergoing endoscopic vs open primary resection were found. Local recurrence rates in patients with positive margins following gross total resection were higher than in patients with negative margins; this was not statistically significant but may be clinically significant.

Meaning  Select patients with sinonasal mucosal melanoma may benefit from endoscopic surgical approaches whereas positive margin status, although a negative prognostic factor, is likely not the main determinant of survival outcomes.

Abstract

Importance  Sinonasal mucosal melanoma (SMM) is a rare malignant neoplasm characterized by a poor prognosis despite aggressive intervention including wide surgical resection. Margin status has previously been cited as an important prognostic factor for local control and overall survival (OS) in patients who undergo either an open or endoscopic surgical approach. No comparisons have been made, however, in patients who have undergone gross total resection with or without positive margins.

Objective  To assess the association of margin status and surgical approach with oncologic outcomes in patients with SMM undergoing gross total resection.

Design, Setting, and Participants  In this cohort study, patients with SMM without evidence of regional or distant disease treated with curative intent in part or full at Memorial Sloan Kettering Cancer Center from 1998 through 2016 were retrospectively assessed. Demographic data, prognostic information, and surgical pathology were reviewed. Operative reports and imaging were used to confirm gross total resection of local disease.

Exposures  Surgical techniques including open maxillectomy, craniofacial resection, and endoscopic resection.

Main Outcomes and Measures  Three-year local recurrence-free survival (LRFS), disease-free survival (DFS), and OS were calculated using the Kaplan-Meier method. Univariate and multivariable analyses of outcomes were carried out using the Cox proportional hazard regression method.

Results  Seventy-two patients (39 [54%] female; mean [SD] age, 67 [12] years) met the eligibility criteria. Thirty-eight patients (53%) underwent open partial or total maxillectomy with or without ethmoidectomy or sphenoidectomy via a transfacial approach. Fourteen patients (19%) had a more extensive craniofacial approach, and 20 patients (28%) underwent endoscopic resection. The 3-year OS for all patients was 52%. The absolute 3-year difference between patients with open/craniofacial resection vs endoscopic resection for LRFS, DFS, and OS was 11% (95% CI, −21% to 43%), 16% (95% CI, −7% to 39%), and 12% (95% CI, −18% to 41%), respectively. The absolute 3-year difference between patients with a negative margin and patients with a positive margin for LRFS, DFS, and OS was 18% (95% CI, −9% to 45%), 5% (95% CI, −17% to 27%), and 15% (95% CI, −9% to 39%), respectively. Multivariable analysis revealed that none of the adjusted variables (margin status, tumor stage, or surgical approach) were significantly associated with OS.

Conclusions and Relevance  Outcomes for patients with SMM remain poor regardless of operative approach or postoperative margin status.

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