**5. Prognosis**

The prognosis of HNMM is relatively dismal, often due to late diagnosis, with 5-year overall survival rate of 25% [116–121] and higher rates of local recurrence and distant metastases than cutaneous melanomas [10, 122, 123].

Distant metastasis is the most common cause of treatment failure. The most common sites for distant metastases are the lungs, followed by the liver, bones and brain [124].

Local recurrence is frequent and commonly associated to positive surgical margins. Advanced age is associated with decreased survival [59, 83, 98, 124–126]. Present of distant metastases, advanced T-category, ulceration, vascular invasion, deep infiltration and male gender are associated with a poorer prognosis too [8, 97].

The multidisciplinary team approach can help reduce morbidity and mortality once optimize treatment, reduce costs and minimize adverse events, while maximizing the chances of recovery. A collaborative interprofessional team includes surgery, medical oncology, radiation oncology, radiology, nuclear medicine and pathology [127]. A multidisciplinary team workup will provide proper appraisal evidence based decision-making, and the most helpful treatment planning and care.
