ISPUB.COM The Internet Journal of Head and Neck Surgery Volume 2 Number 1 1 of 4 Primary Malignant Melanoma Of The Nasal Cavity And Paranasal Sinuses: A Rare Cause Of Epistaxis In The Elderly R Dwivedi, N Samanta, S Agarwal Citation R Dwivedi, N Samanta, S Agarwal. Primary Malignant Melanoma Of The Nasal Cavity And Paranasal Sinuses: A Rare Cause Of Epistaxis In The Elderly. The Internet Journal of Head and Neck Surgery. 2006 Volume 2 Number 1. Abstract Malignant melanoma of nasal cavity and paranasal sinuses is a rare tumor encountered by ENT surgeons. It is so rare that the majority of ENT surgeons do not see even a single case in their lifetime. This paper is a presentation of a case of 58 yrs old male who came in emergency with massive epistaxis. The patient's history revealed recurrent episodes of nasal bleeding for past 3 months. He also complained of progressively increasing nasal obstruction from left nose for 2 months. Nasal endoscopy was done which revealed a smooth pinkish mass in the left nasal cavity, filling the whole middle meatus, and extending till, just anterior to the choana. The nasal endoscopy on the right side was within normal limits. The histopathological examination gave a conclusive diagnosis of Malignant Melanoma. CT scan of PNS confirmed the finding of a localized mass in left nasal cavity with limited extension. INTRODUCTION Melanomas are tumors arising from melanocytes which are neuroectodermally derived cells located in the basal layers of skin, skin adnexa and some of the mucosal membrane. Common sites for melanomas are head, neck and the lower extremities as they are exposed to sunlight, which is one of the predisposing factors. Less common sites of involvement are oral and genital mucosa, nail beds, conjunctiva, orbit, esophagus, nasal mucosa or nasopharynx, vagina and leptomeninges. Primary melanoma of head neck accounts for 25% to 30% of all melanomas ( 1 ). However the incidence of melanomas arising from mucosal surface of aero digestive tract varies from 0.4 to 4% ( 2 ), the majority arising in the nasal cavity or Para nasal sinuses ( 3 , 4 ). The nasal cavity is more commonly affected than the Para nasal sinuses, and the maxillary antrum is more frequently involved than the ethmoid sinuses. The peak age incidence is between fifth and eighth decade ( 5 ), seen slightly more commonly in males than females, although age and sex do not affect the prognosis ( 6 , 7 ). CASE REPORT A 58 yrs old male presented in emergency with massive epistaxis. The patient's history revealed recurrent episodes of off and on nasal bleeding for past 3 months. He also complained of progressively increasing nasal obstruction from left nose since 2 months. A few days after when the patient settled down, diagnostic nasal endoscopy was performed which revealed a pink, smooth mass in the left nasal cavity, filling the whole middle meatus, and extending till choana. The nasal endoscopy on the right side was within normal limits. The biopsy was taken in the same sitting and sent for histopathological examination, which gave a conclusive diagnosis of Malignant Melanoma (Fig.1). CT scan of PNS confirmed the finding of a localized mass in right nasal cavity involving the left anterior and posterior ethmoid sinuses (Fig.2) also blocking the infundibulum of maxillary antrum. There was a mass effect on the left orbit pushing the medial wall. However there was no evidence of direct orbital involvement. Superiorly the mass was extending up to the cribriform plate with possibility of its erosion at some places, however the patient did not have any altered smell or any signs of meningeal irritation. There was no involvement of sphenoid sinuses, regional lymphnodes or any distant organ. The disease was not found eroding nasal septum and was limited to left side only. The Patient did not agree for Surgery and was referred to department of Radiation Oncology for further management.