Head and Neck
Metastatic melanoma to the upper aerodigestive tract
A Systematic Review of the Literature
Matthew Mifsud MD,
Tapan A. Padhya MD,
Corresponding Author
Matthew Mifsud MD
Department of Otolaryngology–Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
Send correspondence to Matthew Mifsud, MD, Department of Otolaryngology–Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., MDC73, Tampa, FL 33612. E-mail: [email protected]Search for more papers by this authorTapan A. Padhya MD
Division of Head and Neck Oncology, University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
Search for more papers by this authorMatthew Mifsud MD,
Tapan A. Padhya MD,
Corresponding Author
Matthew Mifsud MD
Department of Otolaryngology–Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
Send correspondence to Matthew Mifsud, MD, Department of Otolaryngology–Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., MDC73, Tampa, FL 33612. E-mail: [email protected]Search for more papers by this authorTapan A. Padhya MD
Division of Head and Neck Oncology, University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
Search for more papers by this authorThe authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract
This study is a systematic review of the literature that was performed to clarify the natural history and treatment outcomes of upper aerodigestive tract metastases from cutaneous melanoma. A search of the MEDLINE database was undertaken from 1950 to 2013 to identify relevant manuscripts for this review. Article inclusion required cases with documentation of previous cutaneous melanoma primary lesions, adequate survival data, and description of metastatic treatment. Individual patient data were extracted from source articles for analysis of survival outcomes. A systematic search revealed 34 relevant articles with 37 cases for inclusion. Metastases were identified throughout the upper aerodigestive tract with a predilection for the oropharynx, larynx, and oral cavity. Treatment outcomes were estimated with the Kaplan-Meier method, with survival of 37% and 16% at 1 and 5 years, respectively. As expected from previous reports, 73% presented with disseminated disease burden with almost universally poor prognosis despite locoregional or systemic therapy. Conversely, a group of patients with limited metastatic burden had improved treatment response with a 1-year survival of 90%, denoting a hazard ratio of 9.7332 (95% confidence interval, 4.5–21.1) for disseminated disease in comparison. Upper aerodigestive tract metastases of melanoma thus are rare clinical entities that in general present in the setting of disseminated disease and evidently necessitate a focus on palliation. In contrast, for those with a limited metastatic burden, aggressive multimodality therapy including complete metastectomy can produce a significant survival advantage.
Level of Evidence
NA Laryngoscope, 124:1143–1149, 2014
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