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Case Reports
. 2021 Apr 8;57(4):359.
doi: 10.3390/medicina57040359.

Primary Mucosal Melanoma Presenting with a Unilateral Nasal Obstruction of the Left Inferior Turbinate

Nicola Lombardo  1 , Marcello Della Corte  1 , Corrado Pelaia  2 , Giovanna Piazzetta  1 , Nadia Lobello  1 , Ester Del Duca  2 , Luigi Bennardo  2 , Steven Paul Nisticò  2
Affiliations
Case Reports

Primary Mucosal Melanoma Presenting with a Unilateral Nasal Obstruction of the Left Inferior Turbinate

Nicola Lombardo et al. Medicina (Kaunas). .

Abstract

We report the case of a primitive nasal melanoma in an 82-year-old patient, showing how this rare malignancy, with non-specific signs and symptoms, can represent a challenging diagnosis for the physician. A 82-year-old Caucasian patient presented for unilateral nasal obstruction and occasional epistaxis. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the facial massif revealed turbinate hypertrophy and a polypoid phlogistic tissue isointense in T1 with an intermediate signal in T2 and Short-TI Inversion Recovery (STIR)-T2, occupying the middle meatus and the anterior upper and lower left meatus with partial obliteration of the ostium and the infundibulum of the maxillary sinus. The Positron emission tomography (PET) exam was negative for metastases. Conservatory surgery in the left anterior video rhinoscopy was performed, allowing a radical 4-cm tumor excision. Histology reported epithelioid cell melanoma, PanK-, CD45-, and PanMelanoma+. Adjuvant radiotherapy was suggested, even considering a complete resection as the result of surgery. No local or systemic relapse was noticed at the 2-month follow-up visit. Although mucosal melanoma is a rare and aggressive malignancy characterized by a poor prognosis, early diagnosis allows a more conservative approach, with little surgical difficulty and no aesthetic effect. Our case raises awareness of the importance of early intervention even in those cases where the clinic symptoms and diagnostic images show uncertain severity.

Keywords: early diagnosis; mucosal melanoma; nasal lesion; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
MRI T1 weighted images of the facial sinuses (coronal plane). (A) Polypoid voluminous mass extending throughout the left nasal cavity. (B,C) The tumor occupies the middle meatus and anterior side of the superior and inferior left meatus.
Figure 2
Figure 2
MRI (axial plane): (A,B) after administration of gadolinium, no significant signal enhancement was recorded, with the exception of a minimal phlogistic thickening of the parietal mucosa in the left ethmoidal sinus.
Figure 3
Figure 3
(A) Endoscopic examination revealed a purplish-colored polypoid neoformation that obliterates 70% of the left nostril. (B) After mass excision, the neoformation attack site was identified on the inferior turbinate head (arrow) and cauterized. The entire nasal mucosa of the same cavity appears macroscopically clean and free of neoplastic infiltration. (C) The neoformation was extracted en bloc, with a diameter of about 4 cm. The yellow arrow indicates the insertion pedicle. The red arrow indicates the part obliterating the nasopharynx.
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