Melanoma

A study of mucosal melanoma of the oral cavity in India: A rare tumor

August 27, 2014     Pankaj Chaturvedi, MS; Sandeep Lerra, MS(ENT); Piyush Gupta, MS; Prathamesh S. Pai, MS(ENT), DNB; Devendra A. Chaukar, MS, DNB; Jai Prakash Agarwal, MD; Anil K. D'Cruz, MS, DNB
article

Abstract

Malignant melanomas involving the mucosa are rare and aggressive lesions. Their rarity has made the formulation of staging and treatment protocols very difficult, as most of the available information comes from case reports and small case series. We conducted a retrospective study to analyze the behavior of melanomas of the oral mucosa in patients who were treated at Tata Memorial Hospital in Mumbai, a tertiary care referral center for malignancies and one of the largest cancer centers on the Indian subcontinent. During the 22-year period from January 1986 through December 2007, we found only 13 such cases, which had occurred in 8 men and 5 women, aged 26 to 70 years (mean: 37.5). All patients had been offered surgery with curative intent. Mucosal melanomas have exhibited a greater tendency for distant recurrence than for local treatment failure, which is why adjuvant radiation therapy has not been shown to confer any consistent benefit. In our study, only 3 of the 13 patients (23.1%) remained alive 2 years after diagnosis, despite aggressive treatment. Tumor staging, optimal treatment, and prognostic factors for oral mucosal melanoma are far from clear, and further research is needed. Despite the small number of patients in this study, it still represents one of the largest series of oral mucosal melanoma patients in India.

Clinical management of a patient with advanced mucosal malignant melanoma in the sinonasal area

January 21, 2014     Marco Fusetti, MD; Alberto Eibenstein, MD; Ettore Lupi, MD; Enzo Iacomino, MD; Tiziana Pieramici, MD; Alessandra Fioretti, MD, PhD
article

Abstract

We describe a case of mucosal malignant melanoma in the sinonasal area of a 65-year-old woman. She presented with a history of nasal obstruction and epistaxis with subsequent tenderness, facial anesthesia involving cranial nerve V2, red eye, proptosis, diplopia, and conjunctival chemosis. Computed tomography detected a nonspecific solid mass that had involved the left maxillary sinus and surrounding tissues, with extension into the nasal cavity and invasion of the orbital floor and eye muscles. Histopathologic examination of the neoplasm revealed that it was a malignant melanoma. We performed a radical hemimaxillectomy that extended to the orbit, which allowed for radical excision of the tumor. Postoperatively, the patient received adjuvant chemotherapy and radiotherapy. Mucosal melanoma in the head and neck is a rare and highly malignant neoplasm. We suggest that malignant melanoma be suspected when a small-round-cell tumor is found on light microscopy, and we confirm the usefulness of immunohistochemical investigations.

Primary amelanotic melanoma of the nasal cavity: A case report

January 21, 2014     Seema Gupta, MD; Mohan Chand Pant, MD; Nuzhat Husain, MD; Sham Sundar, MD; Huma Khan, PhD
article

Abstract

Primary mucosal malignant melanomas of the nose are rare, accounting for only 0.3 to 2% of all cases of malignant melanoma and about 4% of all head and neck melanomas. The amelanotic variant of mucosal malignant melanoma is even more rare, and the prognosis is poor. This variant usually arises in locations in which it is not noticeable, and therefore it is usually diagnosed at an advanced clinical stage when symptoms eventually manifest. We report a case of locally advanced amelanotic melanoma of the nasal cavity in a 55-year-old woman who presented with complaints of nasal obstruction and intermittent bleeding on the right side of the nose for 3 months and a gradually progressive diffuse swelling over the right periorbital and maxillary areas for 2 months with associated pain for 15 days. She was diagnosed with amelanotic melanoma on the basis of clinical, radiologic, and pathologic findings. In view of her advanced disease, she declined surgery and was treated with chemoradiotherapy, and she experienced a significant alleviation of her symptoms.

Primary mucosal melanoma arising from the eustachian tube with CTLA-4, IL-17A, IL-17C, and IL-17E upregulation

January 24, 2013     Calvin Wei, MD; Sasis Sirikanjanapong, MD; Seth Lieberman, MD; Mark Delacure, MD; Frank Martiniuk, PhD; William Levis, MD; Beverly Y. Wang, MD
article

Abstract

Primary malignant melanoma arising from the eustachian tube is extremely rare. We report the case of a 63-year-old white man who presented with a 1-month history of left-sided hearing loss and aural fullness. Flexible fiberoptic laryngoscopy detected a blue-purple mass that appeared to arise from the left lateral nasopharynx. Computed tomography demonstrated an enhancing mass arising from an orifice of the left eustachian tube. The tumor was debulked endoscopically and was confirmed to have originated in the left eustachian tube. Histologically, the tumor was made up of heavily pigmented pleomorphic spindle cells with frequent mitoses. The tumor cells were immunohistochemically positive for S-100 protein, HMB-45, Melan-A, and PNL-2. The final diagnosis was a mucosal malignant melanoma. We also performed a nested polymerase chain reaction assay for several genes of interest, including CTLA-4, IL-17A, IL-17B, IL-17C, IL-17D, IL-17E, IL-17F, PLZF, Foxp3, RORγt, CD27, and CD70. These genes have been studied mainly in cutaneous melanomas, especially for the development of immunotherapy, but only very limited studies have been done on mucosal melanomas. Our investigation found upregulation of CTLA-4, IL-17A, IL-17C, and IL-17E. Based on our finding of CTLA-4 upregulation, it may be suggested that our patient might have had low antitumor immunity and that he might have benefited from CTLA-4 blockade. On the other hand, upregulation of IL-17A and IL-17E might reflect increased antitumor immunity, which could suggest that patients with a mucosal melanoma might benefit from immunomodulators associated with the effect of Th17. These genes also have great potential to help melanoma patients obtain tailored treatment, and they can be used as biomarkers for predicting prognosis.

Malignant melanoma metastatic to the larynx: A case report

January 24, 2013     Aliasghar Arabi Mianroodi, MD; Tourajreza Mirshekari, MD; Aliakbar Taheri, MD
article

Abstract

Malignant melanoma of the larynx is a rare cancer that can appear as a primary tumor or as a metastasis from a cutaneous head and neck primary. To the best of our knowledge, only 60 cases of primary laryngeal melanoma have been reported in the world literature. Melanomas metastatic to the larynx are even more rare, as only 24 cases have been previously reported. Survival is poor, and recurrence is uncommon. We describe a new case of a malignant melanoma metastatic to the larynx, which represents the first such case in Iran.

Primary mucosal desmoplastic melanoma of the nasal vestibule: The second case

October 26, 2011     Sergio S. Cervantes, MD and Reginald Baugh, MD
article

Abstract

Primary mucosal desmoplastic melanoma is an exceedingly rare, potentially devastating disease that is often initially misdiagnosed because of its deceptively benign presentation. We report what we believe is only the second case of mucosal desmoplastic melanoma arising from the nasal vestibule. The patient, a 62-year-old woman, presented with an obstructive, enlarging mass in the nasal cavity. The tumor, which was initially believed to be benign, was excised, but it recurred 12 months postoperatively. The recurrence was excised, but 4 years later, the patient experienced a second recurrence; in this case, the tumor had invaded the cribriform plate and extended to the anterior cranial fossa. The tumor subsequently metastasized to the dura mater, which led to the patient's death. We review the distinction between conventional mucosal melanoma and mucosal desmoplastic melanoma, and we discuss the ways in which the behavior of a desmoplastic melanoma can point to the diagnosis. Because a diagnosis can be difficult to establish, we stress the importance of maintaining a high index of suspicion when evaluating pathologic and immunohistochemical findings in a patient with a recurrent mucosal nasal mass.

Primary malignant melanoma of the trachea: Case report

June 30, 2010     Engin Çekin, MD, Hakan Cincik, MD, Ismail Yilmaz, MD, and Atila Gungor, MD
article

Abstract

A 22-year-old man was admitted with complaints of dyspnea and hoarseness. Laryngoscopy and computed tomography of the neck revealed a 1.5 x 2-cm solid mass obstructing the trachea. The black, pedunculated mass was completely removed through a tracheal incision, and a paratracheal lymph node dissection was performed. Histopathologic examination revealed nodular-type mucosal malignant melanoma. Cranial and thoracic computed tomography, abdominal ultrasonography, and histopathologic examination of the paratracheal lymph nodes showed no metastases. No recurrence has been noted in more than 3 years of follow-up.

Primary sinonasal malignant melanoma: A clinicopathologic and prognostic study

December 1, 2009     Sudesh Kumar, MS, DNB, Ashok K. Gupta, MS, DLO, MNAMS, Budhi S. Yadav, BS, MD, and Sushmita Ghoshal, MD, DNB
article

Abstract

We conducted a retrospective study to evaluate the clinicopathologic features and prognostic factors associated with primary sinonasal malignant melanoma. We reviewed the records of 10 patients-7 men and 3 women, aged 35 to 70 years (mean: 51.4)-who had been treated at our referral center over a 9-year period. The tumors were located in the nasal cavity in 7 patients and in a paranasal sinus in the other 3. Medial maxillectomy was performed in 4 patients, wide local excision in 3, and endoscopic excision in 2; the remaining patient, who had presented with a liver metastasis, received chemotherapy and palliative local radiotherapy. Two patients who presented with a neck node metastasis also underwent concurrent radical neck dissection. Follow-up ranged from 8 to 70 months (median: 25). Only 4 patients remained alive through the duration of follow-up. The 2- and 5-year survival rates were 60 and 40%, respectively. Based on the findings of our small study, we conclude that primary sinonasal malignant melanoma carries a generally poor prognosis despite aggressive treatment. The primary cause of death in our series was a distant metastasis (n = 5) despite adequate locoregional control in most cases. This finding confirms the aggressive nature of this disease. Other factors that appeared to be associated with a poor prognosis were (1) older age, (2) a primary tumor location in a paranasal sinus, (3) an advanced tumor stage, (4) an external approach to surgery, and (5) the absence of adjuvant radiotherapy.

Malignant melanoma metastatic to the thyroid gland: A case report and review of the literature

January 1, 2009     Brian Kung, MD, Saba Aftab, MD, Moira Wood, MD, and David Rosen, MD
article

Abstract

The thyroid gland is a relatively uncommon site for a secondary malignancy; even less common is a case of malignant melanoma metastatic to the thyroid. We describe the case of a 68-year-old man who presented with a neck mass in the posterior triangle. Fine-needle aspiration biopsy (FNAB) identified the mass as a malignant melanoma. The patient had had no known primary skin melanoma. He underwent a left modified radical neck dissection, and the mass was discovered to be a positive lymph node. Postoperatively, he declined to undergo radio- and chemotherapy. Eighteen months later, he returned with a diffusely enlarged thyroid. FNAB again attributed the enlargement to malignant melanoma. Soon thereafter, the patient began experiencing seizures, and on magnetic resonance imaging, he was found to have metastatic disease to the brain. He developed ventilator-dependent respiratory failure and required a subtotal thyroidectomy for the placement of a tracheostomy tube. Patients who present with a thyroid nodule and who have a history of malignancy present a diagnostic dilemma: Is the nodule benign, a new primary, or a distant metastasis? The findings of this case and a review of the literature strengthen the argument that any patient with a thyroid mass and a history of malignancy should be considered to have a metastasis until proven otherwise.

Melanoma

August 31, 2007     Lester D.R. Thompson, MD, FASCP
article

Bilateral cerebellopontine angle metastatic melanoma: A case report

June 30, 2007     Abraham Jacob, MD; Rebecca P. Brightman, MD; D. Bradley Welling MD, PhD
article
Abstract
Although melanoma accounts for approximately 1% of all malignancies, melanoma metastases to the cerebello-pontine angles (CPAs) are exceedingly rare. Here we describe a patient with melanoma metastases to the internal auditory canals and CPAs who presented with a remote history of cutaneous melanoma. This patient had a rapidly progressive hearing loss, vestibulopathy, and facial nerve dysfunction. Magnetic resonance imaging demonstrated bilateral, enhancing CPA lesions but was otherwise nonspecific. The diagnosis required a careful history, unilateral surgical resection for tissue acquisition, and histopathologic confirmation. A search for primary cutaneous melanoma at the time of presentation was negative. However, the history of cutaneous melanoma 8 years earlier distinguishes this patient's metastatic disease from solitary primary intracranial melanoma, an equally rare disease. Treatment consists of surgical excision, radiation, chemotherapy, and immunotherapy. The prognosis for patients with melanoma metastases is generally poor, but isolated reports of long-term survival have been described. Metastatic disease to the CPAs must be included in the differential diagnosis for any patient presenting with rapid-onset VIIth or VIIIth cranial nerve symptoms.

Malignant melanoma of the sinonasal mucosa: Two case reports and a review

April 30, 2007     Alicia R. Sanderson, MD; Brendan Gaylis, MD
article
 
Page
of 2Next