[PP-264]
Nasal malignant melanoma presenting as a huge mass Nasuhi Engin Aydın, İrfan Öcal, Şemsettin Karaca Katip Çelebi University, Atatürk Training and Research Hospital, İzmir Departments of Pathology (Drs. Aydın and Öcal) and, Dermatology (Dr. Karaca) corresponding author: Dr. Nasuhi Engin Aydin,
[email protected] 61 year old woman who presented with nasal cavity obstruction was suspected of having an inverted papilloma with a possible malignant component following radiologic and clinical work up. An incisional small biopsy of the lesion was diagnosed as malignant melanoma showing diffuse S-100 and HMB-45 positivity along with melanin pigmentation. The greatest dimension of the mass was estimated as 9 cm with MRI. However, detailed investigations could not detect any metastatic focus and detailed dermatologic exam could not find any suspicious melanocytic skin lesion. The patient is alive at the time being, with combined treatment of radiotherapy and chemotherapy following the pathologic diagnosis of seven months ago. Keywords: melanoma, nasal
Low power view of the biopsy showing high cellularity (H.E.X40)
Brain MR with contrast medium showing the huge mass obstucting the left nasal cavity
Diffuse infiltration of atypical cells with scattered granular brownish pigment (H.E.X100)
Large vesicular nuclei with prominent nucleoli and lightly eosinophilic cytoplasm (H.E.X400)
Although sinonasal malignant melanoma (SNMM) accounts for 1% of all melanomas and 2-8% of all malignancies of the nose and paranasal sinuses it is second only to squamous cell carcinoma (SCC). It is regarded as an aggressive and incurable disease. Even though melanocytes are present in the nasal mucosa benign melanocytic lesions are rare and precursor nevoid lesions like cutaneous melanomas are unusual.The adjacent mucosa to a SNMM may show proliferation of intraepithelial melanoma within the basal epithelium as a lentiginous pattern or a pagetoid mode of spread as groups of malignant cells. Over one third of the cases are weakly pigmented or lack pigment making the diagnosis more difficult. Surgery currently offers the best probability of cure and local control of SNMM. Radiotherapy seems to have beneficial effects of locoregional control. The management goals are primary cure and if necessary repetative local salvage surgery. 5 year and 10 year actuarial survival of surgical treatment followed by radiotherapy is around 15-20% and 5-10% respectively.
Diffuse S-100 positivity among the tumor cells (DABX100 and X200)
Diffuse HMB-45 positivity among the tumor cells (DABX100 and X200)
From Moreno MA et al 2010
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