doi: 10.5146/tjpath.2013.01218 Case Report 66 Received : 31.05.2012 Accepted : 09.08.2012 Correspondence: Cem ÇOMUNOğLU Yakın Doğu Üniversitesi, Tıp Fakültesi, Patoloji Anabilim Dalı, LEFKOşA, TURKISH REPUBLIC of NORTHERN CYPRUS E-mail: cemcomunoglu@gmail.com Phone: +90 536 930 70 89 (Turk Patoloji Derg 2017, 33:66-69) ABSTRACT Objective: Sinonasal mucosal malignant melanoma is a rare entity. In this report we present a nasal mucosal malignant melanoma case with its histopathological and clinical features. Case Report: An 88-year-old female patient presented with epistaxis a month ago. Examination revealed a polypoid mass lesion of right nasal cavity originating from the middle concha. Her medical history revealed that she had been found to have a mass lesion in the right nasal cavity 15 months ago. She then underwent a punch biopsy from that lesion. A definitive histopathological diagnosis was not made but it was declared that the lesion had been a malignant epithelial tumor. Te patient then had radiotherapy and the lesion showed complete regression. One year afer completion of radiotherapy, the lesion recurred. Her last PET-CT showed multiple metastatic foci. Endoscopic excisional biopsy was performed for her recurrent lesion. Fragmented tumoral tissues were measured as 3,6x3x0,5 cm. Macroscopically the tumor was brownish in color. Histopathologically the tumor consisted of spindled and epitheloid cells. Immunohistochemically the tumor cells displayed positivity for S-100, HMB-45 and Melan-A. Findings were consistent with malignant melanoma. Discussion: 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. Te 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 afer completion of radiotherapy. For this recurrent tumor, chemotherapy and radiotherapy have been planned. Key Words: Nasal cavity, Malignant melanoma, Radiotherapy Mucosal Malignant Melanoma of Nasal Cavity Recurring a Year After Radiotherapy Cem ÇOMUNOğLU 1 , Gamze MOCAN KUZEY 1 , Mete İNANÇLI 2 , Füsun BABA 1 , Hanife ÖZKAYALAR 1 Department of 1 Pathology and 2 Otolaryngology, Yakın Doğu University, Faculty of Medicine, LEFKOşA, TURKISH REPUBLIC of NORTHERN CYPRUS INTRODUCTION Sinonasal mucosal malignant melanoma (MM) is a rare entity, representing a small proportion of all malignant melanomas. Mucosal melanoma occurs mainly between the fourth and seventh decades (1-3). Tese tumors show high local recurrence rate and the majority of recurrences are reported to be observed within 1 to 2 years afer treatment. It was suggested that defnitive radiotherapy (RT) was curative in a signifcant subset of patients and yielded similar 5-year survival rates compared with surgery. However, it was also claimed that local–regional control had been more efective afer combined surgery and adjuvant RT (4). We herein present a case of nasal MM recurring 1 year afer of completion of defnitive RT. CASE REPORT An 88-year-old female patient presented with epistaxis a month ago. Magnetic resonance imaging (MRI) examina- tion revealed a polypoid mass lesion of right nasal cavity originating from middle concha. Te tumor reached the skull base and lamina papyracea but did not invade beyond (Figure 1). Her medical history revealed that she had mass lesion of the right nasal cavity 15 months ago. She then underwent a punch biopsy from that lesion. A defnitive histopathological diagnosis was not made but it was de- clared that the lesion had consisted of malignant epithelial cells. Because of this biopsy report, the tumor might have incorrectly been thought as carcinoma. Te patient then had RT and the lesion showed complete regression. A year afer completion of her RT, the lesion recurred. Her PET-CT showed multiple metastatic foci in the right and lef lung, liver, lymph nodes (neck, mediastinum, abdo- men) and bone (right scapula, right femur). Endoscopic excisional biopsy was performed for the nasal mass lesion. Fragmented tumoral tissues were measured as 3,6x3x0,5 cm. Macroscopically the tumor was brownish in color. Histopathologically the tumor consisted of spindle and epitheloid cells. Tumoral cells were proliferating mainly in solid and alveolar pattern under ciliated columnar type respiratory epithelium. Mitotic fgures were counted as 14 per 1 mm 2 (Lower than 3 per High Power Field (HPF)).