Objective: To report a rare case of malignant melanoma of the nasolacrimal duct that extends into the nasal cavity, its clinical manifestations, differential diagnosis, prognosis and management options.
Design: Case Report
Setting: Tertiary Hospital
Case Report: A 61-year old male with the chief complaint of bloody epiphora on the right eye and intermittent epistaxis for 11 months was admitted. On physical examination, there was a 2x2 cm mass on the right lateral nasal dorsum, and nasal endoscopy was essentially normal. Orbital CT scan demonstrated a solid-cystic mass on the right lacrimal duct extending from the right medial canthus to the right inferior nasal meatus, which was confirmed by dacryoscintigraphy. Excision biopsy of the right nasal dorsum mass revealed malignant melanoma. The patient underwent 3 cycles of chemotheraphy, however, bloody epiphora and epistaxis persisted. Six months later, the patient was referred to ENT and nasal endoscopy showed a black friable mass emerging from the inferior meatus which revealed malignant melanoma on biopsy. A wide resection was done via medial maxillectomy with orbital preservation. Post-operatively, there were no complications. However, 5 months later, recurrence was noted over the nasal cavity which was confirmed on biopsy.
Conclusion: Mucosal melanoma of the head and neck is a highly malignant tumor representing less than 1% of all melanomas. Prognosis is poor, with a 5-year survival rate of 10-15% and 10-50%, among nasolacrimal duct and paranasal sinus melanoma respectively. Chemotherapy, wide resection and radiation were done on this patient. However, despite aggressive management, the lesion recurs subsequently. The case presented underscores the importance of multispecialty collaboration between the ophthalmologist,
otorhinolaryngologist and oncologist in managing this rare disease.