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Tahiri I, El Houari O, Hajjij A, Zalagh M, Benariba F. Amelanotic Malignant Mucosal Melanoma of the Nasal Cavity: Case Report and Literature Review. Cureus 2022; 14:e22442. [PMID: 35371814 PMCID: PMC8941970 DOI: 10.7759/cureus.22442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/13/2022] Open
Abstract
Sinonasal malignant melanoma is a rare but aggressive tumor of the head and neck area. It has a poor prognosis. Common symptoms are nasal obstruction, epistaxis, or purulent rhinorrhea. Diagnosis relies on histopathology with immunohistochemistry (IHC) studies. Surgery is the essential treatment, most often supplemented by radiotherapy or immunotherapy. A 63-year-old female patient, with a history of right dacryocystorhinostomy and Parkinson's disease, consulted for symptoms of right nasal obstruction with increasing intensity accompanied by two episodes of mild unilateral epistaxis. Rigid optic examination showed a white-pinkish right obstructive supra-centimetric endonasal tumor. CT revealed an extensive tissue process of the right nasal cavity invading the maxillary sinus, the inferior and middle conchas. A biopsy of the lesion was conducted under local anesthesia. The immunohistochemical study has shown undifferentiated tumor with positive antibody anti PS100 and anti-melan A evoking malignant sinonasal melanoma. The patient underwent two surgeries for maxillectomies as she presented a first local recurrence. She was started on adjuvant radiotherapy. At one year of follow-up, she does not present any local or general signs of disease. Sinonasal melanoma is a particular entity of head and neck mucosal melanomas. The highest incidence is described to be in the seventh and eighth decades of life with no sex difference. IHC profiling of different melanoma subtypes showed the importance of alterations in the KIT gene, this genetic data may constitute a therapeutic target. After surgery, the important local recurrence rates and regional failure justify adjuvant radiotherapy also for resections in free margins. Most authors consider that prophylactic neck dissection is not necessary. Preoperative imaging features (CT scan) are characteristic and helpful for diagnosis. IHC is essential, has a high sensitivity for differentiating achromic melanomas from other neoplasms. Sinonasal achromic melanoma is a very uncommon tumor, invasive, and frequently associated with distant metastasis. Paraclinic examinations are essential for staging and guiding therapeutic management. Immunotherapy is a promising ground of research as it comes to metastatic and advanced disease.
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Kieu HD, Le TD, Nguyen V, Tran TQ. Malignant mucosal melanoma of paranasal sinuses: A case report. Int J Surg Case Rep 2021; 87:106450. [PMID: 34592516 PMCID: PMC8488475 DOI: 10.1016/j.ijscr.2021.106450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mucosal melanoma of paranasal sinuses is a rare disease with a challenging treatment and a poor prognosis. In this paper, we reported the successful multimodality treatment of malignant mucosal melanoma of frontal sinus. Case presentation A 65-year-old female presented with a frequent nosebleed for one month before admission. Computed tomography and magnetic resonance imaging showed a mass in the right frontal and ethmoidal sinuses with adjacent bone erosion and right orbit invasion. Biopsy revealed malignant melanoma. No metastasis was found. The definitive diagnosis was malignant mucosal melanoma of paranasal sinuses AJCC stage IVb (T4bN0M0). We used right frontobasal craniotomy to resect tumor for local control of the disease. Immunohistochemical staining was Melan A(+), S100(+), and HMB45(+). A week postoperative, she received adjuvant radiotherapy and immunotherapy (pembrolizumab). For three months postoperative, the patient had no recurrence and metastasis, no headache and no new neurological deficits. She returned to her daily activities. Clinical discussion Mucosal melanoma of paranasal sinuses is usually aggressive and diagnosed at an advanced stage. Management options are surgery, radiation therapy, chemotherapy, and immunotherapy. These options were performed on a case-by-case basis and depend on the extent and location of the tumor. Despite that, the prognosis remains very poor, with a high rate of local recurrences and distant metastases. Therefore, post-treatment lifetime and frequent follow-ups are highly recommended. Conclusion The critical issues in management of mucosal melanoma are early diagnosis, multimodality treatment, and frequent follow-ups. Malignant mucosal melanoma of paranasal sinuses is a rare and complicated disease. The prognosis of this disease remains very poor despite advances in treatment. The critical issues in management are early diagnosis, multimodality treatment, and frequent follow-ups.
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Affiliation(s)
- Hung Dinh Kieu
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam.
| | - Tam Duc Le
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam.
| | - Vu Nguyen
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam.
| | - Trung Quang Tran
- Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam.
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Pontes FSC, de Souza LL, de Abreu MC, Fernandes LA, Rodrigues ALM, do Nascimento DM, Vasconcelos VCS, Soares CD, Corrêa DL, Fonseca FP, de Andrade BAB, Pontes HAR. Sinonasal melanoma: a systematic review of the prognostic factors. Int J Oral Maxillofac Surg 2019; 49:549-557. [PMID: 31767512 DOI: 10.1016/j.ijom.2019.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 10/26/2019] [Accepted: 11/04/2019] [Indexed: 02/03/2023]
Abstract
The objective was to evaluate the available published data on sinonasal melanoma and analyse its clinical features, treatment modalities, and prognostic factors. An electronic search was undertaken in March 2018 in multiple databases. Eligibility criteria included publications with sufficient clinical, histological, and immunohistochemical information to confirm the diagnosis. Seventy-three publications (439 cases) were included. The lesion was more prevalent in females than in males. There was a higher prevalence in the seventh and eighth decades of life. The lesions mainly presented as epistaxis and commonly involved the nasal cavity. Age (>67.6 years; P=0.0012), primary location (middle turbinate; P=0.0112), disease stage (advanced disease stage; P=0.0026), treatment (radiotherapy; P=0.0111), recurrence (recurrence presented; P=0.0137), and distant metastasis (distant metastasis presented; P=0.0011) were independently associated with a lower survival rate. Recurrence was significantly correlated with age (>67.6 years; P=0.0021), sex (males tended to present a higher recurrence rate than females; P=0.0051), disease stage (stages III and IV presented a higher recurrence rate than stages I and II; P=0.0331), and histological type (amelanotic lesions presented a higher index of recurrence than melanotic lesions; P=0.0095). In conclusion, sinonasal melanoma is a neoplasm with a poor prognosis, presenting a 30.69% possibility of survival after 5 years.
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Affiliation(s)
- F S C Pontes
- João de Barros Barreto University Hospital (HUJBB), Federal University of Pará (UFPA), Belém, Pará, Brazil
| | - L L de Souza
- João de Barros Barreto University Hospital (HUJBB), Federal University of Pará (UFPA), Belém, Pará, Brazil.
| | - M C de Abreu
- João de Barros Barreto University Hospital (HUJBB), Federal University of Pará (UFPA), Belém, Pará, Brazil
| | - L A Fernandes
- João de Barros Barreto University Hospital (HUJBB), Federal University of Pará (UFPA), Belém, Pará, Brazil
| | | | | | | | - C D Soares
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - D L Corrêa
- João de Barros Barreto University Hospital (HUJBB), Federal University of Pará (UFPA), Belém, Pará, Brazil
| | - F P Fonseca
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - B A B de Andrade
- Department of Pathology, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - H A R Pontes
- João de Barros Barreto University Hospital (HUJBB), Federal University of Pará (UFPA), Belém, Pará, Brazil; Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Vučinić D, Zahirović D, Manestar D, Belac-Lovasić I, Braut T, Kovač L, Jonjić N, Zamolo G. Recurrent amelanotic melanoma of nasal cavity: Biological variability and unpredictable behavior of mucosal melanoma. A case report. Clin Pract 2019; 9:1157. [PMID: 31285816 PMCID: PMC6589532 DOI: 10.4081/cp.2019.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/27/2019] [Indexed: 11/23/2022] Open
Abstract
The aim of this report is to present a case of a patient with a recurrent nasal cavity amelanotic melanoma (AM), with emphasis on diagnosis and therapy options of this clinical entity. A 65-year-old female patient presented with pain in the right cheek region and nasal obstruction. In 2013, she was diagnosed with mucosal melanoma (MM) of the left nasal cavity. After endoscopic surgery and radiotherapy, the patient was followed by the oncology team. Five years after the initial diagnosis, rhinoscopy showed a tumorous formation in the right nasal cavity. The tumor mass was without black discoloration and was the same color as the surrounding nasal mucosa. Microscopic examination after biopsy of the tumor confirmed amelanotic MM. The patient underwent an additional endoscopic surgery. A complete standard diagnostic workup for MM found metastases in head and neck lymph nodes, on both sides. MMs of head and neck are uncommon malignancies. Unique biology of MM cells causes a high rate of recurrences. This report presents an example of recurrent AM of the nasal cavity, in treatment with checkpoint inhibitor (pembrolizumab), which could provide a good therapy option for patients with MM.
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Affiliation(s)
| | - Dag Zahirović
- Department of Radiotherapy and Oncology, Clinical Hospital Centre Rijeka
| | - Dubravko Manestar
- Faculty of Medicine, University of Rijeka.,Clinic of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Centre Rijeka
| | - Ingrid Belac-Lovasić
- Faculty of Medicine, University of Rijeka.,Department of Radiotherapy and Oncology, Clinical Hospital Centre Rijeka
| | - Tamara Braut
- Faculty of Medicine, University of Rijeka.,Clinic of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Centre Rijeka
| | - Leo Kovač
- Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nives Jonjić
- Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Gordana Zamolo
- Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Kepekci AH, Kig C, Gundogan GI. The evaluation of malignant mucosal melanoma of nasal cavity with a rare occasion. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2018; 10:139-143. [PMID: 30245777 PMCID: PMC6146177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/04/2018] [Indexed: 06/08/2023]
Abstract
Malignant mucosal melanoma is an uncommon disease with a low rate of survival. Malignancies of nasal mucosa which usually presents with nasal obstruction, epistaxis and back drip are difficult to treat and often have poor prognosis. The present case had presented to our clinic with classic symptoms and diagnostic findings of nasal polyposis. Consistently, the patient had previously been diagnosed with and treated for nasal polyposis in another ENT clinic. Physical examination, rhinoscopic examination, computed tomography (CT) scan of the head did not reveal any findings which might imply malignant formations. The operation had been planned for nasal polypectomy and taking deep biopsy specimens. The incised mass showed characteristic features of malignant tissues and the pathology report of the biopsy samples revealed that the specimen showed the histological signs of malignancy. Based on physical examination, CT findings and pathology reports the case was diagnosed as nasal mucosal melanoma. Following an oncosurgical operation, postoperative radio-therapy and chemotherapy were given to the patient and PET/CT examination of the patient did not indicate distant metastases.
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Affiliation(s)
- Ahmet H Kepekci
- Health Occupation High-School, Istanbul Yeni Yuzyil UniversitesiIstanbul, Turkey
| | - Cenk Kig
- Department of Medical Biology and Genetics, Faculty of Medicine, Istanbul Yeni Yuzyil UniversitesiIstanbul, Turkey
| | - Gul I Gundogan
- Department of Histology and Embryology, Faculty of Medicine, Istanbul Yeni Yuzyil UniversitesiIstanbul, Turkey
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Schmidt MQ, David J, Yoshida EJ, Scher K, Mita A, Shiao SL, Ho AS, Zumsteg ZS. Predictors of survival in head and neck mucosal melanoma. Oral Oncol 2017; 73:36-42. [DOI: 10.1016/j.oraloncology.2017.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 02/08/2023]
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Lemetayer J, Al-Dissi A, Tryon K, MacDonald-Dickinson V. Primary intranasal melanoma with brain invasion in a dog. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2017; 58:391-396. [PMID: 28373733 PMCID: PMC5347331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 6-year-old castrated male boxer dog with right-sided dark purulent nasal discharge and acute bilateral blindness was diagnosed on magnetic resonance imaging (MRI) and then on necropsy with primary nasal malignant melanoma that extended into the brain, as well as concurrent ocular melanosis. There was no evidence of metastasis in other organs.
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Abstract
The paranasal sinuses are 4 paired airspaces that border the nasal cavity. Dental professionals are most familiar with the maxillary sinuses as viewed in 2-D imaging (eg, periapical, panoramic projections). With increasing implementation of 3-D imaging, specifically cone beam CT, there is a high probability that much or all of the paranasal sinuses and nasal cavity will be captured in a scan. It is incumbent on practitioners to be familiar with all the structures contained within a scanned area. The purpose of this article is to provide an overview of the anatomy of the nasal cavity as well as common anatomic variants and pathologic entities.
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Affiliation(s)
- Edwin T Parks
- Department of Oral Pathology Medicine and Radiology, Indiana University School of Dentistry, 1121 West Michigan Street, Room S110b, Indianapolis, IN 46202, USA.
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Abstract
OBJECTIVES The aim of this study was to evaluate the long-term effectiveness and complications of radiotherapy (RT) in the treatment of patients with mucosal melanomas of the head and neck. MATERIALS AND METHODS The medical records of 21 patients treated with definitive or postoperative (RT) between 1974 and 2011 at the University of Florida Department of Radiation Oncology in Gainesville, FL, and the University of Florida Proton Therapy Institute in Jacksonville, FL, were retrospectively reviewed under an Institutional Review Board-approved protocol. Primary sites included nasal cavity, oropharynx, and paranasal sinuses. Sixteen patients (76%) received surgery and postoperative RT and 5 patients (24%) received RT alone. Seventeen patients received photon RT alone, whereas 4 patients received combined photon-based and proton-based RT. Median follow-up for all patients was 1.05 years (range, 0.36 to 12.97 y); median follow-up for survivors was 2.2 years (range 0.9 to 13.0 y). RESULTS The 5-year outcomes were: local control, 79%; regional control, 85%; local-regional control, 65%; distant metastasis-free survival, 20%; cause-specific survival, 22%; and overall survival, 22%. Three patients (14%) experienced severe complications including bilateral blindness and skin necrosis. CONCLUSIONS Definitive or postoperative RT for mucosal melanoma of the head and neck yields fairly good local-regional control of disease. The prognosis for patients treated with definitive RT is less promising than for those who receive surgery and postoperative RT.
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Clerico R, Bottoni U, Paolino G, Ambrifi M, Corsetti P, Devirgiliis V, Calvieri S. Melanoma with unknown primary: report and analysis of 24 patients. Med Oncol 2012; 29:2978-84. [DOI: 10.1007/s12032-012-0217-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 03/12/2012] [Indexed: 11/30/2022]
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