Primary sinonasal mucosal melanoma: three different therapeutic approaches to inoperable local disease or recurrence and a review of the literature

Sinonasal melanoma is an uncommon disease with a bad prognosis and a high local recurrence rate, The use of radiotherapy in such conditions remains controversial, A review of the literature is presented in an attempt to answer some of the questions regarding therapeutic options. Data on incidence, aetiology, pathology and prognosis are also provided. Case studies are reported of three patients with sinonasal melanoma referred to our department in a relatively short time period and needing radiotherapy as a single treatment modality, using a conformal three-dimensional treatment technique, One patient was also treated with temporary I-125 seeds, while another was treated using intensity modulation. Both intensity modulation and temporary I-125 seeds are feasible techniques, providing satisfactory dose distributions encompassing the tumour volume while sparing critical structures, Surgery remains the treatment of choice for sinonasal melanoma. Radiotherapy should be used postoperatively and is a good alternative in cases of inoperable disease, Adjacent critical structures limit the radiation dose to the tumour area, especially when high fraction doses are used. Therefore, beam intensity modulation and I-125 seeds can be used to increase the tumour dose without exceeding the radiation tolerance of the surrounding structures. (C) 1998 Lippincott Williams & Wilkins.