Journal of Clinical Oncology, Vol 22, No 4 (February 15), 2004: pp. 745-746
© 2004 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2004.02.059
Unusual Aspects of Melanoma
CASE 2. Regionally Advanced Nasal Cavity Melanoma
Michele Del Vecchio,
Luca Gattinoni,
Laura Lozza,
Emilio Bajetta
Departments of Medical Oncology and Radiotherapy, Istituto Nazionale dei Tumori of Milan, Department of Radiotherapy, Istituto Nazionale dei Tumori of Milan, Milan, Italy
A 45-year-old man was admitted for recurrence of a massive lesion of the left nasal cavity. The patient was previously treated with debulking surgery (tumor resection and left laterocervical node dissection) at another hospital. Pathological examination results had shown a melanoma with involvement of the surgical margins with evidence of micrometastases in only one node.
Physical examination revealed a bulky pigmented mass protruding from the left nasal cavity causing dyspnea and locoregional pain (Fig 1). There was hard, mobile, and painless left laterocervical adenopathy (diameter 2 cm). Moreover, no pigmented or otherwise suspicious lesions were observed on detailed skin examination, allowing for the diagnosis of primary melanoma of the nasal cavity. A whole-body computed tomography (CT) scan revealed a lesion in the left nasal fossa infiltrating ethmoidal cells and hard palate in absence of other disease sites (Fig 2). In absence of a surgical indication due to the locoregional extension of disease, we decided to start a biochemotherapy treatment with cisplatin 30 mg/m2 on days 1 to 3, vindesine 2.5 mg/m2 on day 1, dacarbazine 250 mg/m2 on days 1 to 3, and interferon alfa-2b (IFN -2b) 3 megaunits subcutaneously, three times per week [1]. Chemotherapy was repeated every 3 weeks for six cycles. IFN-2b was interrupted after 4 months when grade 3 asthenia and anorexia appeared. After three cycles, the nasal mass and adenopathy had practically disappeared, while the CT scan showed partial response for persisting bone infiltration. At the end of six cycles, CT scan revealed a complete response confirmed by otolaryngologic evaluation. Following such a clinical response, in order to improve locoregional disease control, the patient received radiotherapy using a field involving nasal and left laterocervical regions (45 and 42.5 Gy, respectively). When considering radiation therapy for melanoma, the influence of the dose fractionation is still uncertain. For this patient, the administered treatment consisted of a 2.5-Gy dose per fraction, for 5 days per week, for a consecutive 26-day period [2]. Radiotherapy was well tolerated, with only mild cutaneous and mucosal acute toxicity. After radiotherapy, CT scan confirmed the complete response in the presence of actinic inflammatory signs, which slowly regressed (Fig 3). The patient is still disease-free (at 25 months+) and in good health (Fig 4).
Head and neck melanomas are rare, with a poor prognosis [3,4], making it difficult to identify the best treatment. Radical surgery is rarely feasible due to the intrinsic aggressiveness of the tumor and close relation with important vascular-nerve structures. Chemotherapy and radiotherapy have shown contradictory results [3]. We decided to use a cisplatin-vindesine-dacarbazine–IFN–based therapy following our previous experience [1] and for the multiple IFN mechanisms of action [5] (cytostatic, immunomodulating, prodifferentiating, and antiangiogenic activities). Our case shows that such a biochemotherapy regimen followed by radiotherapy as maintenance, can be effective in the treatment of locally advanced head and neck melanomas.
Authors' Disclosures of Potential Conflicts of Interest
The authors indicated no potential conflicts of interest.
REFERENCES
1. Bajetta E, Del Vecchio M, Vitali M, et al: A feasibility study using polychemotherapy (cisplatin + vindesine + dacarbazine) plus interferon-alpha or monochemotherapy with dacarbazine plus interferon-alpha in metastatic melanoma. Tumori 87:219–222, 2001[Medline]
2. Sause WT, Cooper JS, Rush S, et al: Fraction size in external beam radiation therapy in the treatment of melanoma. Int J Radiat Oncol Biol Phys 20:429–432, 1991[Medline]
3. Malaguarnera M, Vinci M, Pistone G: Malignant melanoma of nasal cavity: Case report and review of the literature. Cancer Biother Radiopharm 17:29–34, 2002[Medline]
4. Bhattacharyya N: Cancer of the nasal cavity: Survival and factors influencing prognosis. Arch Otolaryngol Head Neck Surg 128:1079–1083, 2002[Abstract/Free Full Text]
5. Williams BRG: Interferon and ß: Basic priciples and preclinical studies, in Rosenberg SA (3rd ed): Biologic Therapy of Cancer. Philadelphia, PA, Lippincott Williams & Wilkins, 2000, pp 194–208
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