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| Year : 2006 | Volume
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| Issue : 4 | Page : 691-693 |
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| Melanotic nasal malignant melanoma - a rare case report |
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S Vinod, KK Hegde
Department of Radio-diagnosis and Imaging , JJM Medical College, Davangere -577004, Karnataka, India
Click here for correspondence address and email
| Date of Submission | 21-Oct-2004 |
| Date of Acceptance | 10-Jun-2006 |
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Keywords: Malignant melanoma, Nasal mass, CT, MRI
How to cite this article:
Vinod S, Hegde K K. Melanotic nasal malignant melanoma - a rare case report. Indian J Radiol Imaging 2006;16:691-3 |
 Introduction | |  |
Malignant melanoma is relatively rare malignancy and constitutes approximately 1-2 % of all malignancies arising in the body. 90% of these occur in the skin. Primary malignant melanoma involving the nasal and paranasal sinus mucosa are rare[1], accounting for less than 1% of all melanomas and also carries poor prognosis. One third of these melanomas are usually amelanotic lesions. In this article we report a case of melanotic malignant melanoma for its rarity and unusual age presentation .
| Case report | | |
A 35 year old lady presented with nasal obstruction and epistaxis since 6months. On local examination, a black glistening mass was seen filling the right nasal cavity . PNS radiograph showed a homogenous opacity in the right nasal cavity with lateral deviation of the nasal septum and haziness within in the right maxillary sinus. Chest radiograph was normal. Routine blood investigations were within the normal limits. CT study of the PNS was performed to know the extent of the mass. CT showed a homogenous soft tissue mass of 47HU enhancing to 70HU predominantly located in the right nasal cavity extending posteriorly into the nasopharynx, superiorly into the right sphenoid sinus, medially destroying the nasal septum and laterally into the right maxillary sinus and the orbit.
The diagnosis of Melanotic Malignant Melanoma was confirmed histopathologically following surgical resection.
| Discussion | | |
Nasal Malignant Melanoma arises from the melanocytes that have migrated during embryologic development from the neural crest to the mucosa of the nose and sinuses. They constitute less than 1% of all melanomas [2]. These melanomas are two or three times more common in the nose than in the sinuses and most frequently arises from the nasal septum, occasionally developing around the inferior and middle turbinates. Less than 25% begin in the Maxillary sinus, antrum being the site in 80% of them. Rarely develop in the ethmoidal sinuses. The frontal and sphenoid sinuses are never involved as primary sites [3].
Nasal melanomas generally develops in patients 50 to 70 years of age . The most common complaints are nasal obstruction and epistaxis with pain, occurring only in 7% to 16% of patients[3] . One third of the melanomas are amelanotic lesions [2].
On CT, Melanomas shows bone remodeling , although element of frank erosions may be present . They are highly vascular tumor so they enhance well on post contrast study. On MRI they are homogenous mass of intermediate signal intensity on all imaging sequences . However, some Melanomas have high T1W signal intensities primarily because of the presence of hemorrhage and to a lesser degree because of the paramagnetic melanin [3].
Wide local surgical excision with or without post operative radiation is the treatment of choice . Upto 40% of patients with Nasal melanoma present with positive neck nodes . Metastases tend to affect the lungs, lymph nodes, brain, adrenal glands, liver and skin [4],[6]. Nasal melanomas have a better prognosis than those tumors originating in the paranasal sinuses . The average survival time of these patients is only 2 to 3 years, and the 10years survival rate is 0.5% [4],[5],[6].
The Differential Diagnosis of Nasal melanoma includes Anaplastic carcinoma, Lymphoma, Embryonal rhabdomyosarcoma, Esthesioneuroblastoma and Extra -medullary plasmocytoma[7].
| References | | |
| 1. | Yoshioka H, Kamada T et al: MRI of mucosal malignant melanoma of the head and neck - J.Comput Assist Tomogr 1998; 22(3), 492-97.  |
| 2. | Mafee MF: Non-epithelial Tumors of the Paranasal sinuses and nasal cavity: Role of CT and MRI- Radiol Clin North Am 1993; 31(1): 75 - 90 |
| 3. | Som PM, Brandwein M: Sinonasal cavities -Inflammatory diseases, tumors, fractures and postoperative findings, In: Head and Neck Imaging Vol 1 , Som PM, Curtin HD (eds), 3rd edition, Mosby, St.Louis 1996; 126-318 |
| 4. | Welkosky HJ, Sorger K, Knuth AM et al: Malignant Melanoma: A clinic pathologic and immunohistochemical study of 14 cases; Am J Clin Pathol 1991; 96: 689-97. |
| 5. | Holdcraft JH, Gallagher JC: Malignant Melanomas of the nasal and paranasal sinus mucosa; Ann Otol Rhinol Laryngol 1969; 78: 1-20. |
| 6. | Freedman HM, Desanto LW, Devine KD et al: Malignant melanoma of the nasal cavity and paranasal sinuses; Arch Otolaryngol 1973; 97: 322-25. |
| 7. | Ogura JH, Schenck NL: Unusual nasal tumors - Problems in diagnosis and treatment; Otolarygol Clin North Am 1973; 6: 813-37 |
Correspondence Address:
S Vinod
Bilwakunja "3574 / 1, 5th Cross, 6th Main, Mcc 'B' Block , Davangere 577004, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-3026.32301
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6] |
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| This article has been cited by | | 1 |
Mucosal Malignant Melanoma of Sino-Nasal Region with Orbital Involvement: Case Report |
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| Jain Shraddha,Madhu Priya,Kumar Sunil | | Indian Journal of Otolaryngology and Head & Neck Surgery. 2013; 65(S1): 178 | | [Pubmed] | [DOI] | | | 2 |
Primary malignant melanoma at unusual sites: An institutional experience with review of literature |
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| Das, P., Kumar, N., Ahuja, A., Jain, A., Ray, R., Sarkar, C., Gupta, S.D. | | Melanoma Research. 2010; 20(3): 233-239 | | [Pubmed] | |
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