Behandlungsmöglichkeiten des malignen Melanoms des Gaumens, der Nasenhöhle und der Nasennebenhöhlen

Zusammenfassung

Nur ein kleiner Teil der malignen Melanome im Kopf-Halsbereich befällt die Schleimhäute.

60% davon wachsen in der Nase und den Nebenhöhlen, 30% in der Mundhöhle und ca. 10% im pharyngealen Raum (USA: 34%; 50%; 15%). Die 5-Jahres-Überlebensrate liegt bei 15-17%.

Die Tumoren werden elektrisch reseziert, zusammen mit einer Ausräumung der ableitenden Lymphknoten. Besonders beachtet werden müssen beim Melanom der Nase die Lymphknoten der Schädelbasis und beim Melanom der Wange und des Alveolarkammes die Lymphknoten entlang der V. facialis.

Summary

Malignant melanomas of the mucous membranes are rare. Statistics reveal an incidence of 8-9% in all head and neck melanomas. The tumour predominates in the nasal cavity and the paranasal sinuses in the statistic compiled by Eneroth and Lundberg and in our patients (60%), while Conley found that in the USA the oral cavity contains half of the melanomas. 34% only were situated in the nose.

The prognosis is very poor, because of the hidden localisation, insufficient signs and high malignancy of these tumours. The five-year survival rate is 15-17%. The treatment of choice is extensive local electrodesiccation together with a radical neck dissection, or local cryosurgery. Maximal attention has to be given to the topmost lymph nodes at the base of the skull in melanomas of the nasal cavity. They can be removed after resection of the digastric muscle and elevation of the parotid gland. In case of a massive involvement of the lymphatic tissue at the skull base, the dorsal half of the vertical mandibula can be removed to gain broad access to the skull base, the pterygoid fossa and the retro-mandibular space.

Neck dissection in cases of tumours of the buccal region and the alveolus must include the buccal lymph nodes concomitant with the facial vein. They are situated lateral to the horizontal part of the mandible.