Sinonasal Mucosal Melanoma: A Comprehensive Review and Clinical Experience

Sinonasal malignant melanoma is an extremely rare and aggressive malignancy. Diagnosis is often delayed because of nonspecific symptoms and complex histopathology. The primary treatment is surgical resection, with adjuvant radiotherapy frequently employed, although its survival benefit remains controversial. Systemic therapies, including immunotherapy and targeted therapy, show limited efficacy compared with cutaneous melanoma, partly due to distinct genetic profiles. The authors present the experience of a single-referral center with 10 patients diagnosed with sinonasal malignant melanoma. Despite treatment, which primarily involved surgery with adjuvant radiotherapy (n=7), outcomes were poor, with frequent recurrence and metastasis. Only one patient who achieved clear surgical margins and received adjuvant radiotherapy remained disease-free for more than five years. Based on these data, achieving clear surgical margins and establishing an early diagnosis are critical prognostic factors in the treatment of sinonasal mucosal melanoma. Management of this condition remains challenging, and no standardized treatment protocol has been established. Continued investigation and research are imperative to develop definitive therapeutic approaches.