From the Research
The ideal resection margins for sinonasal mucosal melanoma are typically 1-2 cm of normal tissue surrounding the tumor when anatomically feasible, as suggested by the most recent and highest quality study available 1. However, achieving these margins is often challenging due to the complex anatomy of the sinonasal region and proximity to critical structures like the orbit, skull base, and brain. In practice, surgeons often aim for complete macroscopic resection with negative margins on frozen section, even if the 1-2 cm margin cannot be achieved throughout. Some key points to consider in the management of sinonasal mucosal melanoma include:
- Endoscopic approaches are increasingly used for these resections, with the goal of complete tumor removal while preserving function and quality of life 2, 1.
- Due to the aggressive nature of sinonasal mucosal melanoma and its high recurrence rates, surgery is typically followed by adjuvant therapy such as radiation or immunotherapy, regardless of margin status 3, 1.
- The surgical approach should be individualized based on tumor location, extent, and patient factors, with the understanding that even with negative margins, local recurrence rates remain high for this aggressive malignancy 4, 1.
- The reliability of intraoperative frozen margins for sinonasal mucosal melanomas has been questioned, with a false-negative margin rate of 25% reported in one study 5, highlighting the need for careful consideration of margin status in the management of these tumors. Overall, the management of sinonasal mucosal melanoma requires a multidisciplinary approach, taking into account the complex anatomy of the sinonasal region, the aggressive nature of the tumor, and the need for individualized treatment planning to optimize outcomes.