RARE CASE OF NASAL CAVITY MELANOMA

Case report: A 74-year-old man started an investigation for epistaxis, nasal obstruction, and left facial pain. A sinus computed tomography (CT) scan showed an expansive lesion affecting the entire left nasal cavity to the base of the skull. The patient underwent biopsy of the lesion, whose anatomopathological and immunohistochemical study confirmed nasal cavity melanoma. Subsequently, he underwent treatment with exclusive radiotherapy (RT), due to the extent of the disease and patient performance, in tumor bed, 30 sessions, daily dose of 2 Gy, totaling 60 Gy. Significant improvement of symptoms, without obstructive complaints, after 9 months of treatment, has stable disease and exclusive clinical follow-up – CT of the abdomen and chest without evidence of disease; Bone scintigraphy with little likelihood of secondary involvement. Discussion: Nasal mucosa melanoma is an extremely rare and aggressive tumor, corresponding to 1.3% of melanomas; the first case was published in 1869; peak incidence is between the 6th decade of life. Risk factors are exposure to ultraviolet rays and tobacco. The case clinic corresponds to the main symptoms shown in studies, and the standard treatment is surgery followed by RT, but articles show good local control with only RT, as seen with our patient. The average survival in patients who underwent both treatments is 18 months, our case remains without evidence of distant metastasis and disease evolution, 9 months after the treatment. Final Comments: We present a case of nasal cavity melanoma, as it is a rare and very aggressive malignant neoplasm. Although there was no standard treatment, surgery followed by RT, the patient remains asymptomatic and without metastatic evolution of the disease, as shown by tests. Further studies should be conducted for treatment improvements.