Patients

We retrospectively analyzed patients with metastatic mucosal melanoma of nasal cavity and paranasal sinuses who received DTIC followed by combination of CP at National Cancer Center Hospital from 2011 to 2013. During this period, 551 cases of melanoma were referred to our department. Of these cases, 77 (14.0%) were mucosal melanoma, including 27 of nasal cavity and paranasal sinuses origin.

Of these 27 cases, 23 were metastatic melanoma of nasal cavity and paranasal sinuses. Of the 23 cases, 7 were treated with DTIC followed by combination of CP, which we retrospectively analyzed in this study. All the seven patients were in Stage IV C (Tables 1 and ​and3).3). Of the other 16 cases, 4 cases were treated with DTIC monotherapy, 4 with palliative care alone, 4 to clinical trials, 1 received nivolumab, 1 underwent surgery, 1 was treated by CP alone, and 1 was transferred to another hospital.

Clinical characteristics of 7 patients with metastatic mucosal melanoma of nasal cavity and paranasal sinuses.

Clinical features and treatment response in 7 patients.

It was reported that the combination therapy of CP treatment was effective in head and neck malignancies.¹⁵ Thus, the cost for combination of CP could be covered by the Japanese governmental health insurance plan, and when DTIC failed, we were able to give the combination to nasal and paranasal metastatic melanomas, which were located in the head and neck region.

Attending doctors decided to change from DTIC to the combination of CP after obtaining consent from individual patients with the explanation that, although it was reported that CP combination therapy may be effective for head and neck malignancies, and thus covered by the Japanese governmental health insurance plan, the effectiveness of CP combination was not directly proven in metastatic mucosal melanoma.

The medical records of all eligible patients were reviewed, and clinical parameters, including sex, age, primary site, performance status, number of metastatic organs, serum lactate dehydrogenase levels, and number of treatment cycles, were recorded.