MELANOMAS DE CABEZA Y CUELLO. UN TEMA SIEMPRE POLÉMICO (PARTE I)

Abstract

Background: Extention of cutaneous cover of head and neck is cause that 25-35% of all melanoma appear in that body area. Incidence is about 4-6/1 000 000/year. More of 90% is diagnosed in visible areas of head and neck, then, success treatment is sometimes difficult and in other imposible to access. Mucous melanomas are 1-7% of all melanomas and 55% of them are placed in head and neck. Estimation of its incidence is about 0.2/100 000/year. Between ocular melanomas , uveals one are most frequent followed by conjunctival ones. Mana- gement is incumbent of different Specialities. That is the reason why it results a polemic and controversial issue.

Objective: To Discovery risk factors of survival and relapse in one serie which analyse all cutaneous and extracutaneous melanomas of head and neck in a period of 16 years.

Design: Retrospective, observational and bibliographic revision.

Setting: Public Hospital of tertiary care.

Population: 157/309 were female patients with 1.03/1 rate to male. Middle age was 61.23 (21-93) years old. Near 82% were cutaneous melanomas and the rest non- cutaneous. Most than a half were localized at the face followed in less proportion by extra-cutaneous, sculp, neck and auricular. In 253 cutaneous, 99 were superficial spreading were dominant, followed by nodular and lentigo maligno melanoma. 112 of them were of intermediate thickness, 93 thin and 48 thick. In mucosal melanomas, palate was the site of election with 39.2%, pa- ranasal sinuses with 16%. Ocular melanomas represent 42.8% of extracutaneous melanomas. 19 of them were uveal and 5 conjunctival. Most of the sample -185- belonged to III stage, followed by 85 in stage I and 72 in stage II.

Methods: Extention of surgery was local with free margin in 230 patients of all the sample and extended to near tissues in 79. In non- cutaneous melanomas, surgery varied from local resection in 13/56 -23.2% patients, ocular enucleation in 25%, orbit exenteration in 9%, maxilectomy in 35.7%, craniofacial resection in 3 and nasal amputation in 1. In same proportion, patients received cervical dissection -50.2 vs 49.8%. 61.5% received adjuvant chemotherapy and 6.1% radiotherapy. Mean follow-up of the sample was 50 (1-120) months.

Results: Surgical morbidity was 13.2% and mortality 0.003%. 120/309 -38.8%- patients developed recurrentes, At 24 months, 58.3% of recurrences had been diagnosed. In multivariate analysis, only the localization in the face was sttiscally significant against those localized in the sculp. At close of observation 155 patients were dead. Overall survival at 10 years was 58% and free of disease 52%. In non-cutaneous melanomas, 41/56 -73.2%- patients were dead, 35/41 -85.3%- of them for specific cause and the rest for other diseases. In multivariate analysis, only the site, the thickness and stage were statiscally significant.

Conclusions: They were different for cutaneous and non-cutaneous. At close of observation overall survival was 58% at 10 years and free of disease of 52% in the same interval of time. In the multivariate analysis only the site, thickness and stage were statiscally significant. In the analysis of only non-cutaneous melanomas, surgical morbility was 51.7% and mortality 1.7%. 67.8% of all non-cutaneous melanomas developed recurrences befote 5 years and 95% of them was dead in same interval of time. New paradigms of treatment for extracutaneous disease are urgently needed for a disease which outcome sustantially has no changed in the last 20 years, different what happened in cutaneous melanomas.