The role of radiotherapy in the management of sinonasal melanoma and its impact on patients and healthcare professionals.

The aim of this paper is discuss the contemporary issues surrounding radiotherapy for sinonasal mucosal melanoma (SNMM). SNMM is a rare disease with a poor prognosis. The particular challenge with regard to radiotherapy for SNMM is that melanoma is a relatively radioresistant tumour in an anatomical site surrounded by important radiosensitive structures. IMRT has been shown to be an effective primary and adjuvant therapy, and is superior to traditional photon radiotherapy techniques. Emerging evidence also supports the role of particle therapy. Protons and carbon ions may provide a superior target dose and less collateral damage than IMRT. Stereotactic radiotherapy has also been used successfully. The introduction of new technology will always be inhibited by financial constraints and concerns about long-term efficacy. The role of the health professional will change commensurate with the introduction of new technology in terms of the knowledge and the clinical skills they must acquire. Working patterns may need to change to manage the competing interests of expanding services and financial cutbacks. In addition to the clinical expertise health professionals provide, they will be charged with the responsibility of finding innovative ways to improve and develop radiotherapy services for SNMM.