Mucosal malignant melanoma of nasal cavity recurring a year after radiotherapy

Abstract

Mucosal malignant melanomas have a poor prognosis despite chemotherapy and radiotherapy. Five-year survival for sinonasal melanoma is reported to be lower than 35%. Sinonasal melanomas show a high recurrence rate. The immunohistochemical markers showing high specificity for malignant melanoma such as S-100, HMB-45 and Melan-A are used in order to reach a correct diagnosis. In our case the tumor showed recurrence and multiple metastases 1 year after completion of radiotherapy. For this recurrent tumor, chemotherapy and radiotherapy have been planned.

Sinonasal malignant melanoma

“…The differential diagnosis consists in the histopathological differentiation of a chronic inflammation or a sinonasal malignancy (intestinal or non-intestinal adenocarcinoma, squamous cell carcinoma with different degrees of keratinization, undifferentiated carcinoma, adenoid-cystic carcinoma). The primary tumor site / initial tumor origin is usually difficult to determine due to the extent of the lesion 13 . Our patient consulted an ENT doctor after several episodes of nasal bleeding, but the macroscopic appearance of the lesion led to a preoperative diagnosis of chronic rhinosinusitis with nasal polyposis, the histopathological examination showing malignant melanoma of the sinonasal mucosa.…”

“…Cervical lymph node metastases occur in 10-50% of patients. Distant metastases occur in 40-76% of patients in the lungs, liver, brain, skin and the orbit 10,13,14 . In our case in particular, no lymph node metastases were detected, both at diagnosis and in oncological follow-up, but the last imaging examination raised the suspicion of a distant, right adrenal metastasis, which is to be biopsied to establish certainty.…”

“…The treatment of choice is ablative surgery with free resection margins. However, the complex anatomy of the sinonasal cavities near some vital structures makes it impossible to obtain tumor-free resection margins, with important aesthetic and functional sequelae, unjustified by a distant metastasis rate of more than 40% [12][13][14][15] . The approach used may be endoscopic, external, or combined, depending on the extent of the lesion.…”

“…Local recurrence occurs in 29-79% of cases, despite aggressive local surgery. Some authors recommend adjuvant radiotherapy for local disease control 10,14 , while other authors have reported a lack of beneficial response to survival rate 9,11,13 . Irradiation dose information and technique are inconsistent in the current literature.…”

Increased 68Ga-FAPI Activity in Chondrosarcoma of Nasal Cavity

“…Chondrosarcoma is a malignant mesenchymal cartilage forming tumor, which mainly appears in long bones and pelvis, but rarely in nasal and paranasal sinuses 1–3 . The differential diagnosis of chondrosarcoma of nasal cavity on PET/CT images mainly includes primary sinonasal yolk sac tumor, 4 metastatic tumors, 5 inverted papilloma, 6 malignant melanoma, 7 and primary intestinal-type adenocarcinoma 8 . In recent years, 68 Ga-FAPI has been developed as a promising imaging agent for fibroblast-activating protein because of the overexpression of fibroblast activation protein in cancer-associated fibroblasts 9–12 .…”