Giant Mucosal Melanoma of the Nose

A 41-year-old Bolivian woman presented at the Department of Head and Neck Surgery of the University of São Paulo Medical School with a 5-month history of a black nodule protruding through the right nostril. The tumor increased rapidly, with occasional bleeding. At physical exam, the patient was in good clinical conditions, with no comorbidities. An 8.2-cm black mass destroying part of the nasal pyramid was evident ( Figure 1 ). Computed tomography showed that the mass did not extend to the paranasal sinuses. Preoperative workup did not demonstrate regional or distant disease. The patient was submitted for a total extended rhinectomy, with no flap reconstruction ( Figure 2 ). The final pathology report was a mucosal malignant melanoma with free margins. An external prosthesis was custom made, with good cosmetic result. The patient was followed up for 15 months after the operation, with no evidence of disease. This photo case report was approved by the institutional review board of the Hospital das Clínicas of the University of São Paulo Medical School.

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Figure 1.

An extensive tumor protruding through the right nostril and destroying the nasal pyramid.

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Figure 2.

The final result after extended total rhinectomy, 5 months after the operation.

Mucosal melanomas of the upper aerodigestive tract are unusual tumors, comprising less than 1% of all malignant melanomas. ¹ They are very aggressive cancers, with a diagnostic delay due either to its deep location or to misdiagnosis, leading to the advanced stage of most patients at initial presentation.^2,3 In addition to the local extension of these rapidly growing neoplasias, distant metastases are frequent. Because of the reduced survival rates, ⁴ every effort should be made to perform aggressive palliation, usually with wide local excision with adequate functional and cosmetic rehabilitation. ⁵ This objective was clearly achieved in the present case, offering reasonable quality of life, despite the disfiguration caused by the resection and the poor prognosis.