DOI: 10.36347/sjmcr.2022.v10i09.017

Pages: 928-936

Nasal mucocal melanoma is a rare and aggressive neoplasm. In most cases, it arises in the lateral wall of the nasal cavity. As it shows nonspecific clinical symptoms and risk factors, anterior nasofibroscopy and imaging plays a crucial role in the diagnosis. The final diagnosis is based on histological and immunohistochemical findings. The wide surgical excision is the mainstay of the treatment and the adjuvant radiotherapy is often used to prevent local recurrence and metastasis. We report a case of a 61 years old female patient with obstruction and epsistaxis. The first facial magnetic resonance imaging was suggestive of an inverted papilloma misleading the diagnosis. The patient had undergone nasal endoscopy with a biopsy. The histological and immunohistochemical were consistent with the diagnosis of a mucosal melanoma. A facial computed tomography revealed a solid mass filling the entire right nasal cavity with extension to the homolateral ethmoidal cells and the maxillary sinus and erosion of the middle and lower turbinates and the nasal septum. A second facial magnetic resonance imaging showed a neoformation of the right nasal cavity. The lesion was initially removed using and endonasal endoscopic approach. Local recurrence occurred one month later, which leaded to perform a lateral rhinotomy approach. The histopathological aspect was consistent with the diagnosis of malignant melanoma and the patient received a postoperative 3D radiation therapy. The diagnosis is based on histological and IHC studies. Wide surgical excision with negative margins is the cornerstone of any treatment regimen for sinonasal mucosal melanoma followed by adjuvant radiotherapy even if there is no clear consensus. In spite of a well conducted treatment, the melanoma of the nasal cavity remains an aggressive tumor with a non-negligent risk of local recurrence, with a poor prognosis and a survival rate not exceeding 35% after 5 years.