Endoscopic and open surgical approaches to locally advanced sinonasal melanoma comparing the therapeutic benefits

Importance This study helps to elucidate the appropriate surgical treatment for sinonasal melanoma.

Objective To compare open resection (OR) and endoscopic resection (ER) as surgical approaches to sinonasal mucosal melanoma (SNM)and evaluate their associations with treatment-related outcomes.

Design, Setting, and Participants Retrospective review of the medical records of 25 patients with sinonasal mucosal melanoma (SNM) treated by either OR or ER in an academic tertiary care medical center.

Interventions The patients underwent either OR or ER of their SNM tumors.

Main Outcomes and Measures Overall survivalwas the primary outcome measured; secondary outcomes were postoperative complications, lengths of hospital stay, patterns of failure, and disease-free survival.

Results Thirteen patients with SNM underwent an OR, while 12 had ER of their tumors. The OR and ER groups did not differ significantly in demographic and tumor characteristics. In the OR vs ER group comparisons, mean age (67.8 vs 65.5 years) (P = .63), the proportions of patients who received adjuvant radiotherapy (85%[n = 11] vs 92%[n = 11]) (P > .99), and the proportion who achieved negative surgical margins on resection (54%[n = 7] vs 58%[n = 7]) (P = .82) were similar. Overall all median survival (12.7 and 1.9 years) (P = .87) and disease-free survival (1.9 and 1.2 years) (P = .72) were modest and did not differ between OR and ER groups, respectively. Likewise, the OR and ER groups, respectively, showed comparable mean lengths of hospital stay (3.6 and 3.8 days) (P = .87), rates of postoperative bleeding (8%[n = 1] and 17%[n = 2]) (P = .59), and rates of cerebrospinal fluid leak (15% [n = 2] and 25%[n = 3]) (P = .64). In addition, the OR and ER groups, respectively, had high rates of local (23%[n = 3] and 8%[n = 1]) (P = .59), distant (15%[n = 2] and 25%[n = 3]) (P = .64), and multiple failures (15%[n = 2] and 25%[n = 3]) (P = .64).

Conclusions and Relevance This retrospective study of a rare disease suggests that endoscopic resection of sinonasal melanoma offers an attractive, minimally invasive surgical option. In the hands of an experienced surgeon, an endoscopic approach yields survival and morbidity outcomes comparable to those of an open approach.