Melanoma maligno de fosa nasal, a propósito de un caso

  1. Santos Gorjón, Pablo
  2. Gil Melcón, María
  3. Franco Calvo, Fernando
  4. Guardado Sánchez, Luis Alberto
  5. Rey Marcos, María
  6. Gómez González, Juan Luis
Revista:
Revista ORL

ISSN: 2444-7986,  2444-7986

Any de publicació: 2012

Volum: 3

Pàgines: 179-185

Tipus: Article

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Altres publicacions en: Revista ORL

Resum

Introduction: The melanoma of the nasal fossae represents a 4% of all sinonasal malignant tumors. The symptoms are unspecific, thus delaying diagnosis. We present a case of a woman of 80 years of age. She has hypertension and a degenerative heart disease, and presents nasal respiratory insufficiency, left otalgia and epistaxis of 8 months of evolution. Examination revealed a dark, polypoidal, fleshy mass. The CT revealed a mass that occupied that space, without bone erosion. A biopsy of the mass revealed that it was an amelanotic melanoma. Due to the age of the patient and her general pathology, endoscopic sinonasal surgery was applied. The pathological anatomic analysis confirmed that it was a malignant round cell melanoma with the following phenotype: positive for Vimentin, positive for nuclear S-100, focal positive for HMB-45, negative, melan A+ negative for HMB-45 with heterogeneous intensity, and negative for ENE and ALC. The patient did not present symptoms until a year later, when she discovered a small laterocervical adenopathy. A FNAP confirmed that the melanoma had metastatized. The patient underwent a radical neck dissection and remained 15 months without symptoms. She is currently going through monthly revisions. Discussion: The treatment of choice is surgery. Selective neck dissection is not justified. This tumor is radioresistant. Active immunotherapy (a combination of Interferon and Cimetidine) and targeted chemotherapy have also been used, mainly in inoperable cases. Five-year survival ranges between 6.5% and 34%. Conclusion: We propose endoscopic surgery for non-infiltrating tumors or for patients who cannot undergo very aggressive surgery due to their general condition.

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