Sunday, May 21, 2017

Updated by Piper Wenzel, BS April 2024

Overview

  • A rare malignant and aggressive tumor arising from the nasal mucosa (Salari 2022)
  • Most common in the 5th to 8th decades, median age of 70 years; similar incidence in males and females (Salari 2022)
  • Often presents with nonspecific nasal symptoms - epistaxis, nasal obstruction, facial pain, headache (Salari 2022, Andrianakis 2021)
  • More advanced stage lesions may involve the orbit/skull base resulting in neurologic symptoms, diplopia, and/or proptosis (Salari 2022)
  • Often delayed in diagnosis due to lack of specific symptoms in earlier stages and anatomical location (Salari 2022, Andrianakis 2021)
  • Poor survival - "average 5-year OS (overall survival) rate not exceeding 35%" (Andrianakis 2021)
  • Possible risk factors include exposure to tobacco/formaldehyde, African/Japanese ancestry, and pre-exiting sinonasal melanosis (Salari 2022)
  • Primary treatment has been reported to be surgical excision with or without radiation (Salari 2022)

Radiologic Findings

  • On CT: non-contrast shows a lobular soft tissue mass and benign bone remodeling; contrast shows diffuse enhancement
  • On MR:
    • T1: UNIQUELY high signal, occasionally amelanotic melanomas will only have intermediate signal
    • T2: Hypo- to hyperintense
    • T1 post-contrast: Enhancing lesion, although difficult to determine true enhancement due to high T1 signal regardless of contrast use
Non-contrast CT
melanoma_CTwo_0804

References

Andrianakis A, Kiss P, Pomberger M, Wolf A, Thurnher D, Tomazic PV. Sinonasal mucosal melanoma: treatment strategies and survival rates for a rare disease entity : A single center experience and review of literature. Wien Klin Wochenschr. 2021 Nov;133(21-22):1137-1147. doi: 10.1007/s00508-021-01847-6. Epub 2021 Apr 12. PMID: 33844113; PMCID: PMC8599389.

Salari B, Foreman RK, Emerick KS, Lawrence DP, Duncan LM. Sinonasal Mucosal Melanoma: An Update and Review of the Literature. Am J Dermatopathol. 2022 Jun 1;44(6):424-432. doi: 10.1097/DAD.0000000000002157. Epub 2022 Mar 22. PMID: 35315370.