Radioguided surgical strategy in mucosal melanoma of the nasal cavity

Sinonasal mucosal melanoma (MM), although very rare (< 1% of the all MM), is second only to squamous cell carcinoma among cancers of the nasal region and still represents a challenging problem in head and neck cancer. A 60-year-old woman had nasal MM stage 1, which was treated with concomitant probe-guided tumor excision and an elective neck dissection after sentinel lymph node biopsy. The radioactivity status of the tumor and lymph nodes were compared with the histopathologic specimen. Surgical margins, sentinel lymph node, and lymphadenectomy were free of tumor. The patient was seen in frequent and regular follow-up and was free of disease without any other treatment (radiotherapy, immunotherapy, or chemotherapy). Radioguided surgery is an easy and reproducible surgical technique that could increase the likelihood of adequate excision and minimize the development of nodal disease by performing a "guided" neck dissection after the sentinel lymph node biopsy. A multidisciplinary approach and further studies with a longer follow-up are needed to substantiate the accuracy and safety of this strategy in the treatment of an aggressive neoplasm like MM of the head and neck, which still has a very poor prognosis.