Melanoma on nose
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Melanoma on the Nose: An Overview
Incidence and Rarity of Nasal Melanoma
Primary Malignant Melanoma of the Nose
Melanoma of the nose is an exceptionally rare condition, accounting for less than 1% of all melanomas and less than 4% of sinonasal tumors . Historically, the incidence of nasal melanoma has been low, with only a few cases reported in the literature over the decades . For instance, Allen and Spitz (1953) found only eight cases of nasal cavity melanoma out of 934 cases of malignant melanoma. Similarly, Moore and Martin (1955) reported nine cases out of 1546 melanomas originating in the nasal fossa.
Clinical Presentation and Diagnosis
Symptoms and Detection
Patients with nasal melanoma often present with nonspecific symptoms such as nasal obstruction, epistaxis (nosebleeds), and occasionally, visible pigmented lesions . These symptoms can lead to delays in diagnosis, as they are common to many other less severe conditions. For example, a 70-year-old female patient reported a feeling of nasal blockage, which upon further investigation revealed a large polypoidal mass extending to the nasopharynx.
Histopathological Features
Histologically, nasal melanomas do not differ significantly from melanomas found in other parts of the body. They originate from melanoblasts, the cells responsible for melanin production, and can vary considerably in appearance. Immunohistochemical analysis often shows positive results for markers such as S-100, HMB-45, and Melan-A, which are crucial for confirming the diagnosis .
Treatment Approaches
Surgical Intervention
Early and radical surgical excision remains the primary treatment modality for nasal melanoma, offering the best chance for a cure . Wide local excision with skin grafting is often recommended, and in cases of nodal metastasis, a modified neck dissection or superficial parotidectomy may be necessary. Endoscopic resection is also an option for limited tumors, providing outcomes comparable to more invasive open approaches.
Radiation and Other Therapies
Radiation therapy is generally considered less effective for nasal melanoma compared to other nasal carcinomas. However, it may be used in cases where surgical options are limited due to the patient's health or tumor location. Other treatments, such as intraoral vaccination and intra-arterial infusion, have been explored but are not widely adopted.
Prognosis and Survival Rates
Survival Statistics
The prognosis for nasal melanoma is generally poor due to its aggressive nature and the tendency for late diagnosis. Survival rates vary, with some studies reporting a two-year survival rate of 82%, but a significant drop to 29% at five years and 12% at ten years. The presence of histologically positive lymph nodes is a critical factor, as all patients with nodal involvement in one study succumbed to the disease.
Importance of Early Detection
Early diagnosis is crucial for improving outcomes. High suspicion and prompt investigation of nasal symptoms can lead to earlier detection and treatment, potentially improving survival rates .
Conclusion
Nasal melanoma is a rare but highly aggressive form of melanoma with a poor prognosis. Early and radical surgical intervention remains the cornerstone of treatment, while radiation therapy and other modalities play a supportive role. Due to its rarity and nonspecific symptoms, heightened awareness and prompt diagnostic measures are essential for improving patient outcomes.
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