Endoscopic versus Open Approaches in Management of Sinonasal Melanoma
Background: Sinonasal melanoma (SNM) accounts for 5% of all malignant neoplasms of the nasal cavity and paranasal sinuses. It is an aggressive malignancy with a high rate of metastasis and 2-year overall survival rate of 30%. Although rare, the overall incidence of SNM is on the rise. Knowing this a...
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| Published in: | Journal of neurological surgery. Part B, Skull base Vol. 76; no. S 01 |
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| Main Authors: | , , , , , , , |
| Format: | Conference Proceeding Journal Article |
| Language: | English |
| Published: |
18-02-2015
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| Online Access: | Get full text |
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| Summary: | Background:
Sinonasal melanoma (SNM) accounts for 5% of all malignant neoplasms of the nasal cavity and paranasal sinuses. It is an aggressive malignancy with a high rate of metastasis and 2-year overall survival rate of 30%. Although rare, the overall incidence of SNM is on the rise. Knowing this and considering the increased utilization of nasal endoscopy in the resection of anterior skull base tumors, comparison of traditional open craniofacial resections to endoscopic resections in SNM is warranted.
Methods:
A 10-year retrospective review of 26 patients with SNM treated at an academic tertiary care center from July 2004 to July 2014 was conducted. Overall, 17 patients were managed endoscopically, 7 patients through traditional open techniques, and 2 patients through a combined approach. Comparisons of stage, anatomic extension of disease, completeness of resection, operative time, blood loss, length of hospitalization, recurrence rates, and complications were performed.
Results:
The majority of endoscopic cases were stage I-II while the majority of open or combination approaches were stage III-IV. Patients with concern for orbital or intracranial involvement were more likely to undergo an open or combination approach. However, concern for cribriform involvement did not affect approach choice. Similar rates of negative margins were achieved with the two approaches (88% endoscopic vs. 86% open). Shorter operative times and length of hospitalization were noted with the endoscopic approach. Significantly less estimated blood loss was achieved with the endoscopic approach (340 mL endoscopic vs. 1,120 mL open). Recurrence rates were similar for all approaches (47% endoscopic, 42% open, and 50% combined). Complications were more common with open and combined approaches (18% endoscopic vs. 67% open/combined).
Conclusion:
Surgical management of SNM continues to evolve. Most tumors can be safely removed endoscopically which may lead to decreased intraoperative blood loss, shorter hospitalization, and less complications. There is still a role for open resections for more advanced disease with concern for frontal sinus, orbit, or intracranial extension. |
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| ISSN: | 2193-6331 2193-634X |
| DOI: | 10.1055/s-0035-1546594 |