Malignant Amelanotic Melanoma of the Middle Ear

Abstract

We report the first case (to our knowledge) of malignant melanoma of amelanotic type arising from the mucosa of the middle ear. An 81-year-old man who presented with right hearing loss was diagnosed as having otitis media with effusion at an otolarygology clinic. Despite subsequent treatment, he developed otorrhea and otalgia. Furthermore, a granular mass was found in the pars flaccida of the tympanic membrane. A biopsy of the mass was performed, and the findings were suggestive of malignant melanoma. The disease was already in an advanced stage, because metastases were noted in the patient's lungs and liver. Although chemohormonal therapy was performed and was slightly effective in reducing the primary tumor, the patient died of acute renal failure. Autopsy confirmed the diagnosis of amelanotic melanoma of the middle ear.

Mucosal melanocytic lesion in the middle ear extending to the inner ear and nasopharynx

“…8 Additionally, cellular blue nevi are clinically similar because they can reach large sizes. 9 The histological features of our patient showed submucosal pigmented lesions. With high power, the lesion contained heavily pigmented macrophages and few scattered melanocytes with fibrosis.…”

Malignant Melanoma of the Middle Ear

“…5 Of the previous cases, only 1 patient survived to 8 months after presentation, when he succumbed to metastatic disease. [1][2][3] It has been 10 months since this patient's diagnosis, and no evidence of disease has been seen on otoscopic examination or surveillance imaging.…”

A Systematic Review of Primary Temporal Bone Mucosal Melanoma

“…Challenges in the timely diagnosis of temporal bone MM are secondary to the nonspecific nature of associated symptoms and the absence of clear risk factors. In addition, the clinical course of many of these temporal bone MM follows an insidious progression that may masquerade as more benign conditions including serous otitis media or otomastoiditis (7,11,18–23). More than a third of the patients in this review were initially misdiagnosed, although this number may be higher because of potential underreporting.…”

“…In the current review, the diagnosis of MM was able to be confirmed through biopsy results in the majority of patients (76.0%). However, it is worth mentioning that obtaining biopsies could exacerbate the rate of tumor growth (11,18,33). Multiple imaging modalities may be useful for evaluating temporal bone MM.…”