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Sinonasal Melanoma - Radiology

last modified on: Thu, 04/25/2024 - 11:37

Updated by Piper Wenzel, BS April 2024

  • A rare malignant and aggressive tumor arising from the nasal mucosa (Salari 2022)
  • Most common in the 5th to 8th decades, median age of 70 years; similar incidence in males and females (Salari 2022)
  • Often presents with nonspecific nasal symptoms - epistaxis, nasal obstruction, facial pain, headache (Salari 2022, Andrianakis 2021)
  • More advanced stage lesions may involve the orbit/skull base resulting in neurologic symptoms, diplopia, and/or proptosis (Salari 2022)
  • Often delayed in diagnosis due to lack of specific symptoms in earlier stages and anatomical location (Salari 2022, Andrianakis 2021)
  • Poor survival - "average 5-year OS (overall survival) rate not exceeding 35%" (Andrianakis 2021)
  • Possible risk factors include exposure to tobacco/formaldehyde, African/Japanese ancestry, and pre-exiting sinonasal melanosis (Salari 2022)
  • Primary treatment has been reported to be surgical excision with or without radiation (Salari 2022)
  • On CT: non-contrast shows a lobular soft tissue mass and benign bone remodeling; contrast shows diffuse enhancement
  • On MR:
    • T1: UNIQUELY high signal, occasionally amelanotic melanomas will only have intermediate signal
    • T2: Hypo- to hyperintense
    • T1 post-contrast: Enhancing lesion, although difficult to determine true enhancement due to high T1 signal regardless of contrast use

References

Andrianakis A, Kiss P, Pomberger M, Wolf A, Thurnher D, Tomazic PV. Sinonasal mucosal melanoma: treatment strategies and survival rates for a rare disease entity : A single center experience and review of literature. Wien Klin Wochenschr. 2021 Nov;133(21-22):1137-1147. doi: 10.1007/s00508-021-01847-6. Epub 2021 Apr 12. PMID: 33844113; PMCID: PMC8599389.

Salari B, Foreman RK, Emerick KS, Lawrence DP, Duncan LM. Sinonasal Mucosal Melanoma: An Update and Review of the Literature. Am J Dermatopathol. 2022 Jun 1;44(6):424-432. doi: 10.1097/DAD.0000000000002157. Epub 2022 Mar 22. PMID: 35315370.