Melanomas no cutáneos de cabeza y cuello enfermedad de pronóstico sombrío / Non-cutaneous melanoma of the head and neck disease of grim prognosis

Antecedentes: Los melanomas no cutáneos representan el 1-7% del total. Su pronóstico es malo, a pesar de lo cual, los avancestecnológicos pueden haber cambiado su evolución.Objetivo: Descubrir factores que permitan determinar los progresos de los últimos 20 años.Diseño: Retrospectivo, observacional.Lugar de aplicación: Hospital Público de atención terciaria.Población: 30/56 pacientes pertenecían al género masculino, con una relación 1.15/1. La edad media fue 61.07 años. El sitiodominante de los mucosos fue paladar con 22 (39.2%) y senos paranasales con 9 (16%). Los oculares con 24/56 representaron el(42.8%) de la muestra. El 94.6% se hallaban en E I.Métodos: La extensión de la cirugía varió desde la simple resección local en 13/56 -23.2%- pacientes, a la enucleación ocular en14/56 (25%), exenteración orbitaria en 5/56(9%), maxilectomía superior en 20/56 (35.7%), resección craneofacial en 3 y amputaciónnasal en 1.Resultados: La morbilidad fue 51.7% y la mortalidad 1.7%. El 67.8% desarrolló recurrencias. El análisis univariado para recurrenciademostró que los orígenes rinosinusal y conjuntival, influyeron desfavorablemente en el evento recurrencia. Al cierre de laobservación 42/56 (75%) habían fallecido, (85.8%) de ellos por causa específica. Solo 2/42 (4.7%) muertes se produjeron despuésde los 60 meses. La supervivencia libre de enfermedad a 5 años fue 31.9%. El paladar y el E I, fueron las variables que a su favorconservaron significación estadística.Conclusiones: Urgen nuevos paradigmas de tratamiento para esta enfermedad cuya evolución no se ha modificado sustancialmenteen los últimos 20 años.

Background: Non cutaneous are 1-7% of all melanoma. The prognosis is poor in spite of which, technological progress maychange the outcome.Objective: To discover factors which allow to define progress of last 20 years.Design: Retrospective, observational.Setting: Public Hospital of tertiary care.Population: 30/56 male patients with 1.15/1 rate. Mean age 61.07 years old. Priority sites in mucosal melanoma were palate with22-39.2% and paranasal sinus with 9 (16%). Ocular melanomas were 42.8% of the sample. 94.6% were EI.Methods: Extention of surgery was simple resection in 13/56 (23.2%), ocular enucleation in 14/56 (25%), orbit exenteration in 5/56(9%) maxilectomy in 20/56 (35.7%), craniofacial resection in 3 and nasal amputation in 1.Results: Morbility was 51.7% and mortality 1.7%. 67.8% of the sample recurred. Multivariate analysis for recurrence showed thatrinosinusal and conjuntival sites unfavorably influence on that event. At close of observation 42/56 (75%) was dead, 85.8% of themfor specific cause. Only 2 death happened after 60 months. Five years specific survival was 31.9%. Palate and stage I were favorablesites with statistic significance.Conclusions: Other paradigms of treatment are urgently necessary for this disease which outcome was not substantially modifiedin the last 20 years.

Estudo retrospectivo de melanomas cutâneos e mucosos na população do estado do Rio Grande do Norte, Brasil / Retrospective study of cutaneous and mucosal melanomas in the population of the state of Rio Grande do Norte, Brazil

INTRODUÇÃO E OBJETIVOS: O melanoma é uma neoplasia maligna que pode acometer a pele e as mucosas. A taxa de incidência do melanoma cutâneo de forma geral tem aumentado nos últimos anos. Esta pesquisa realizou uma análise retrospectiva de melanomas cutâneos e mucosos no período de 30 anos em um serviço do Rio Grande do Norte, enfatizando características clínicas, conduta e evolução dos melanomas mucosos orais. MATERIAL E MÉTODO: Nos prontuários clínicos, foram coletadas informações sobre idade, raça, sexo, localização o tipo de comprometimento da lesão, se primária ou metastática. RESULTADOS: Um total de 397 casos de melanoma foi diagnosticado, sendo 332 cutâneos (83,6 por cento) e 46 mucosos (11,6 por cento). O tronco foi mais acometido (27,7 por cento), seguido por membros inferiores (24,7 por cento) e cabeça e pescoço (18,9 por cento). Entre os melanomas mucosos, a maioria era de cabeça e pescoço (76,1 por cento). De forma geral, 52,4 por cento ocorreram em indivíduos do sexo masculino e 47,6 por cento, no feminino. A idade média foi de 54,9 anos. Nos homens esteve mais presente nas sétima e oitava décadas de vida, e nas mulheres, nas quinta e sexta décadas. Seis casos (1,5 por cento) acometeram a mucosa oral e estes ocorreram mais em indivíduos do sexo feminino, acima de 55 anos. CONCLUSÃO: O perfil epidemiológico dos casos de melanomas avaliados se assemelha aos poucos estudos epidemiológicos publicados, apesar de alguns dados, no tocante a sexo e idade em determinadas localizações anatômicas, terem variado e a incidência de melanomas orais ter sido bem mais baixa do que a relatada na maioria das pesquisas.

INTRODUCTION AND OBJECTIVES: Melanoma is a malignant neoplasm that occurs in the skin and mucosae. Overall, the incidence rate of cutaneous melanoma has increased in the last years. It was performed a retrospective analysis of cutaneous and mucosal melanomas diagnosed within a period of 30 years in one health care institution of Rio Grande do Norte, highlighting clinical features, approach and evolution of oral mucosal melanomas. METHODS: Data as to age, race, gender, tumor topography and lesion involvement (metastatic or primary) were collected from clinical records. RESULTS: A total of 397 cases of melanoma were diagnosed, 332 of them were cutaneous (83.6 percent) and 46 of them were mucosal (11.6 percent). The trunk was the most affected area (27.7 percent), followed by lower limbs (24.7 percent) and head/neck (18.9 percent). Within the mucosal melanomas, most cases were on head and neck (76.1 percent). By and large, 52.4 percent affected male individuals and 47.6 percent affected female patients. The mean age was 54.9. Among men it was more prevalent in the 7th and 8th decades of life, whereas among women it was more prevalent in the 5th and 6th decades of life. A total of 6 cases (1.5 percent) occurred in the oral mucosa, with more prevalence among female individuals over 55 years of age. CONCLUSIONS: The epidemiological profile of the analyzed cases of melanoma was similar to the few published epidemiological studies, although some data on gender and age in certain anatomical sites varied and the incidence of oral melanoma was much lower than that reported in most investigations.