General Medical Information

Malignant Melanoma

Sharen J. Knudsen
Byron J. Bailey

Melanoma of the sinonasal tract is second only to squamous cell carcinoma in frequency, according to the Armed Forces Institute of Pathology otorhinolaryngology records. About 25% of cutaneous lesions occur in the head and neck region. The primary endonasal site of origin is the nasal septum, where tumors manifest as pigmented masses. Pain, swelling, nasal obstruction, and epistaxis are the main symptoms. Even with surgical treatment, a 50% recurrence rate is reported. Prognosis is poor. The median survival rate for oronasal melanoma is 2 years, and the 5-year survival rate is 25%. Advanced age is an adverse prognostic factor. Among the reasons for this poor prognosis are lack of symptoms with early disease, difficulty achieving wide excision margins, and the rich blood supply in the area. Wide local excision is recommended as the most effective mode of primary therapy. Lymph node dissection is not usually used to manage stage N0 disease because of the low incidence of nodal metastasis in the absence of local recurrence or distant metastasis.