Adjuvant radiotherapy in sinonasal mucosal melanoma: A
R.J. Baatenburg de Jong
Department of Otorhinolaryngology and
Head and Neck Surgery, Erasmus University
Medical Center (EMC), Rotterdam, The
J.A.U. Hardillo, Department of
Otorhinolaryngology and Head and Neck
Surgery, Erasmus University Medical Center
(EMC), Rotterdam, The Netherlands.
Objectives: Evaluation of outcome after curative treatment for sinonasal mucosal
melanoma focused on the effect of adjuvant radiotherapy on recurrence and survival.
Design: Retrospective chart analysis.
Setting: Tertiary referral hospital.
Participants: Fifty-one patients with primary sinonasal mucosal melanoma who
underwent surgical resection with curative intention between 1980 and 2016 at
Erasmus Medical Center, Rotterdam.
Main outcome measures: Patients were categorised into 2 groups: surgery alone
and surgery with adjuvant radiotherapy. Log-rank test was used to compare rates of
recurrence and survival between treatment groups. Predictors for treatment modal-
ity, recurrence and survival were assessed with multivariate statistical analysis.
Results: Of all patients, 23.5% developed local recurrence and 47.1% developed dis-
tant metastasis. Estimated 5-year disease-free survival was 25.2%, and 5-year over-
all survival (OS) was 38.1%. Forty-three patients (84.3%) were treated with post-
operative radiotherapy. Patients who underwent surgery with adjuvant radiotherapy
presented more often with high tumour stage, tumour involving multiple sites and
positive margins. Post-operative radiotherapy seemed to be associated with better
local control (P = .549). No effect was found on occurrence of distant metastasis
and OS. Positive margin status was an independent negative predictor for distant
metastasis-free survival and overall survival.
Conclusions: Our treatment outcomes are consistent with literature. Post-operative
radiotherapy seems to be associated with improved local control despite advanced
disease and positive margin status in this treatment group.
Sinonasal mucosal melanoma is a rare malignancy with a reported
incidence rate of 0.05 per 100 000 in the United States.
Netherlands, this disease accounts for 8% of all sinonasal malignan-
The prognosis is poor, with an estimated 5-year overall sur-
vival (OS) of 21.8%-40.1%.
The aggressive behaviour of this
tumour results in advanced disease at diagnosis and high rates of
local (38%-46.6%) and distant recurrence (34.6%-66%).
Due to the low incidence of this disease, the development of a
standardised treatment protocol and prognostic models has been dif-
ficult. Surgical resection with clear margins has been the key mode
of treatment with curative intent.
Ideally, all unilateral mucosa
should be removed, as this malignancy often presents with multifocal
lesions that could easily be missed. However, given the complex
anatomy of the sinonasal tract with close relation to vital structures,
radical resection is often hard to achieve.
In case of incomplete
resection, post-operative radiotherapy is advocated. No consensus
Accepted: 11 November 2017
Clinical Otolaryngology. 2018;43:617–623. wileyonlinelibrary.com/journal/coa © 2017 John Wiley & Sons Ltd