1NAANANI Othmane, 2A. Rhnia, 3S. Tarek, 4M. Lahjaouj, 5M. Loudghiri, 6W. Bijou, 7Y. OUKESSOU, 8S. Rouadi, 9R.L. ABADA, 10M. ROUBAL, 11M. MAHTAR
1,2,3,4,5,6,7,8,9,10,11ENT and Cervicofacial Surgery Department, CHU Ibn Rochd, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca.
ABSTRACT
Background: Sinonasal mucosal melanoma is a rare and aggressive malignancy, accounting for less than 1% of all melanomas. Due to its nonspecific symptoms and deep anatomical location, diagnosis is often delayed. Management is challenging and typically relies on surgical resection, with or without adjuvant radiotherapy.
Case Presentation: We report the case of a 62-year-old woman with a history of right orbital exenteration who presented with a gradually enlarging left endonasal mass. Initial histopathological examination revealed an undifferentiated tumor. One year later, the patient developed left- sided nasal obstruction and intermittent epistaxis. A second biopsy confirmed the diagnosis of malignant melanoma. Imaging revealed a polylobulated, enhancing mass occupying the left nasal cavity, with extension to the ethmoid cells, olfactory fossa, nasal vestibule, and close contact with adjacent sinus structures. Surgical management included a combined endonasal and Rouge-Denker approach with septectomy, resection of the medial maxillary wall, and a Draf IIa frontal sinusotomy. Complete tumor resection was achieved, and postoperative recovery was uneventful.
Conclusion: Sinonasal malignant melanoma remains a diagnostic and therapeutic challenge due to its rarity and aggressive behavior. This case highlights the importance of a multidisciplinary approach, combining detailed imaging, immunohistochemistry, and tailored surgical strategies to optimize outcomes in this uncommon and often misdiagnosed entity.
KEYWORDS
Sinonasal melanoma, mucosal melanoma, nasal cavity tumor, endoscopic surgery, Rouge- Denker approach, malignant melanoma, case report.
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