Background: Primary sinonasal malignant melanoma represents a rare entity with poor prognosis. In order to increase the diseasefree survival complex treatment approach is recommended (incl. surgery, postoperative radiotherapy (RT) and combined chemotherapy (CCT).
Methods: A clinical case of a 64-year old male patient with locally advanced sinonasal malignant amelanotic melanoma with a 2-year follow-up is presented. The optimal treatment strategy is discussed, based on the literature review.
Results: In a case of locally advanced sinonasal malignant amelanotic melanoma local tumoral control was achieved by using combined treatment modalities (surgery with mediofacial resection, postoperative RT, several courses of CCT and surgery again). After two years regional disease recurred with involvement of the contralateral neck lymph nodes. There was no evidence of distant spread.
Conclusions: The late lymphatic spread of the mucosal melanoma points out the necessity of thorough staging of the neck lymph nodes already at first presentation. In locally advanced mucosal melanoma postoperative RT should be carried out. There is still no uniform opinion on the optimal radiation schedule, the fractionation, the overall dosis and the target volume.
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Увод: Синоназалните малигнени меланоми са редки заболявания с лоша прогноза. За подобряване на свободната от заболяване преживяемост се препоръчва комплексно лечение (хирургия, следоперативна лъчетерапия (ЛТ) и полихимиотерапия (ПХТ)).
Материал и метод: Представяме нашите 2-годишни наблюдения при 64‑годишен пациент с локално авансирал синоназален ахроматичен меланом. На фона на литературни данни се обсъжда оптималното комплексно лечение при това рядко срещано заболяване.
Резултати: След комбинирано лечение (медиофациална резекция, следоперативна ЛТ; 5 курса ПХТ и реоперация) бе постигнат локален туморен конрол (ЛТК) при локално авансирал меланом на околоносните кухини. Две години след лечението бе диагностициран контралатерален регионален рецидив, без далечно метастазиране.
Заключение: Късното лимфно метастазиране при мукозните меланоми, обосновава необходимостта от прецизиране на шийния нодален статус още при диагностициране на заболяването. При локално авансиралите мукозни меланоми се налага провеждане на следоперативна ЛТ, чийто оптимално фракциониране, доза и обем все още не са определени.
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