Presentation
Male who began clinical symptoms a year ago with nasal obstruction and epistaxis.
Patient Data
Nasal cavity with expansive lesion showing areas of hemorrhage and ulceration with extension to the cavity right nasal, involvement of nasal turbinates and septum. Inferiorly it extends towards soft tissues of the labial region with erosion of the bony palate, extending behind to the nasopharynx with partial occlusion.
It presents important volume effect remodeling nasal walls sides, laterally displacing the medial wall of the maxillary sinuses and medial wall of the left orbit with compression of the eyeball and displacement of the optic nerve, superiorly with erosion of the cribriform plate without identifying intracranial extension.
Left nostril with expansive mass, irregular, lobulated edges, heterogeneous behavior with predominantly hypointense on T1, isointense on T2, with heterogeneous enhancement after gadolinium administration, with some hyperintense areas on T1 that could be related to rich areas in melanin, intralesionally with some tortuous and dilated vascular pathways that show blooming artifice in HEMO sequence with absence of signal in T1 and T2, measures 7.4 x 9.4 x 9.6 cm.
Patient with histopathological report for melanoma.
Case Discussion
Sinonasal melanoma is a malignant neoplasm with a poor prognosis, being initially asymptomatic, it presents a late diagnosis with symptoms of nasal obstruction and epistaxis.
The best diagnostic tool is magnetic resonance imaging where we will observe a melanotic-type melanoma with a high signal on T1 due to melanin, metal ions or hemorrhage.
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