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Case 122

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A 59-year-old white skinned patient attended an ENT outpatient clinic complaining of right unilateral nasal obstruction for the past 8 months, recurrent mild nosebleeds and loss of 7 kilos (246.9 ounces or 15.4 pounds) in the past 60 days. The patient denied any other nasal discharge. He had well-controlled hypertension and denied smoking, alcohol intake or any other comorbidities. During rhinoscopy, a lesion was found and photographed. There were no enlarged lymph nodes and no alterations were observed on mouth or ear examination.

Based on the clinical history and image provided, which is the most likely diagnosis?

a) Nasal polyposis

25%

b) Mucosal leishmaniasis

25%

c) Melanoma

25%

d) Squamous cell carcinoma

25%
   

Comments

- Mucosal melanomas of the nasal cavity are tumors arising from rare melanocytes with no established risk factors.

- Clinical presentation often includes: nasal obstruction, recurrent mild epistaxis and nasal congestion.

- The diagnosis might be suspected during close inspection and is confirmed by histopathological evaluation. Computed tomography plays an important role in staging the disease.

- Wide surgical resection forms the mainstay of treatment. Radiotherapy, chemotherapy and immunotherapy are ineffective.

- The prognosis is generally poor owing to the high rates of local recurrences and distant metastases. 

References

- Andrade BAB, Piña AR, León JE, Almeida OP, Altermani A . Primary nasal mucosal melanoma in Brazil: clinicopathologic and immunohistochemical study of 12 patients. AnnDiagPathol 2012;16:344-49.

Lessa MM, Lessa HA, Castro TWN, Oliveira ASA, Machado P etal . Leishmaniose mucosa: aspectos clínicos e epidemiológicos. Rev. Bras. Otorrinolaringol. 2007;  73: 843-847

- Gomes CC, Sakano E, Lucchezi MC, Melo RRG. Melanomas mucosos naso-sinusais. Rev. Bras. Otorrinolaringol. 1993; 59: 202-206

- Uysal IO, Misir M, Polat K, Altuntas EE, Atalar MH,Tuncer E et al. PrimaryMalignantofthe Nasal Cavity. J CraniofacSurg. 2012; 23: e2-e5

Gorjón PS, Melcón MG, Calvo FF, Sánchez LAG, Marcos MR et al. Melanoma maligno de fosa nasal, a propósito de un caso. Rev. Soc. Otorrinolaringol. Castilla Leon Cantab. La Rioja. 2012. 3:179-185

Authors

Juan Bernard Nascimento dos Santos - 6th year medical student of UFMG School of Medicine

E-mail: juanbernard[at]gmail.com

Júlio Guerra Domingues – 5th year medical student of UFMG School of Medicine

E-mail: jgdjulio[at]gmail.com

Supervisors

Flávia Vasques Bitterncourt – member of the Department of Internal Medicine (UFMG School of Medicine).

E-mail: flaviavb[at]task.com.br

Rafael Fernandes Goulart dos Santos – Otorhinolaryngology resident physician at  Otorrinolaringologia do Hospital Universitário da Universidade Federal de Juiz de Fora, in Juiz de Fora, Brazil.

E-mail: rafaelfgsantos[at]gmail.com

Reviewers

Fabiana Resende, Glauber Eliaazar and professor Viviane Parisotto

Translated by

Lucas Resende Lucinda, 6th year medical student of UFMG School of Medicine.
E-mail: lucasresendebh[at]hotmail.com

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