Nasal Melanoma Research Articles

Perioperative anesthetic challenges in a patient with malignant nasal melanoma

Perioperative anesthetic challenges in a patient with malignant nasal melanoma

Nasal Malignant Melanoma With an Inverted Papilloma in the Contralateral Nasal Cavity: A Case Report.

Background: We describe a patient with sinonasal mucosal melanoma (SNMM) and an inverted papilloma, which existed independently in both nasal cavities. Case presentation: We describe an unusual case of a 74-year-old male patient with SNMM and an inverted papilloma. He presented with symptoms of coughing up blood and pain in the left forehead. The patient underwent surgical resection of the lesion, and the SNMM and inverted papilloma were confirmed by histopathology. The patient refused further treatment after surgery, but was re-admitted 7 months later with local recurrence of the left tumor and systemic metastases. Conclusions: Nasal malignant melanoma with an inverted papilloma in the contralateral nasal cavity is rare and can easily be misdiagnosed as the same tumor by imaging. Simultaneous histopathology of bilateral nasal masses is very necessary. The recommended treatment is surgery for the inverted papilloma. An SNMM is a devastating tumor with poor outcomes.

Epistaksis ve Köpeklerdeki Klinik Yansımaları: 2007-2017 Arasında Kaydedilmiş 34 Vaka

Objective: Epistaxis is a relatively remarkable clinical symptom in dogs that should be included in the differential diagnoses of diseases. Material and Methods: The present author's interest in this subject arose following receipt of several cases within the last 10 years. The purpose of the present article was to evaluate 34 dogs with epistaxis retrospectively. Results: There was bilateral (n=13) or unilateral (n=21) epistaxis, in which chronicity was evident in 13 dogs. Etiology deemed infectious (n=28), non-infectious (n=5) and unknown origin (n=1) causes. The infectious causes involved 13 cases with canine visceral leishmaniasis and other 9 with canine monocytic ehrlichiosis, followed by 6 co-infected dogs. Activated partial thromboplastin time was significantly (p<0.001) prolonged in coinfected groups. Regarding mean prothrombin time, a statistically important prolongation (p<0.001) was evident among leishmaniasis within other groups. Mean FIB values deemed elevated among all infected groups in contrast to healthy ones (p<0.001). Mean platelet values were decreased in E. canis mono and co-infected groups (p<0.001). Non-infectious diseases consisted of firearm injury (n=2), nasal malignant melanoma (n=1), lymphoma (n=1) and autoimmune hemolytic anemia (n=1). Conclusion: Taking into account review of this case series, it might be suggested that epistaxis should be on the list of clinical signs for infectious and non-infectious causes, which should be promptly treated based on probable tests and relevant findings.

P0441CONCOMITANT MEDICATIONS OR IMMUNE CHECHKPOINT INHIBITOR, WHO IS THE CAUSE OF ACUTE TUBULOINTERSTITIAL NEPHRITIS IN IMMUNOTHERAPY?

Abstract Background and Aims During the last decades, the incidence of drug-associated acute tubulointerstitial nephritis (ATIN) has markedly increased. In the recent years, immune checkpoint inhibitors (ICI) have shown promising results in the treatment of malignancies such as melanoma or lung cancer. Immune mediated adverse events are frequent during the use of these drugs as a result of their mechanism of action. The most common kidney lesion in ICI-treated patients who present acute kidney injury (AKI) is ATIN. It is well established that classical drug-induced ATIN is an allergic drug hypersensitivity reaction mediated by T lymphocytes that occurs 7-10 days after exposure. On the contrary, the pathomechanism of ICI-related ATIN remains controversial. Together with the hypothesis that ATIN is a hypersensitivity reaction against ICI itself, other authors propose that loss of inhibition of T cells may facilitate hypersensitivity reactions to previously tolerated drugs or kidney antigens. Method We reviewed 3 cases of ICI-associated ATIN diagnosed in our nephrology unit with known concomitant medications associated to ATIN. The main demographical, clinical and analytical variables such as gender, age, type of malignancy and oncological treatment were recorded. Results: Patient 1 A 70 year-old man was diagnosed with a non-small-cell lung carcinoma in June 2018. He was treated with carboplatin, paclitaxel and nivolumab (first cycle 21st June 2018), and underwent lobectomy. NSAIDs were prescribed on September 2018 after surgery. Creatinine was normal at baseline. On September 2018 (110 days after nivolumab initiation and 7 days after NSAIDs prescription) he was admitted to the nephrology unit due to AKI, and the kidney biopsy revealed ATIN. ICI and NSAIDs were discontinued. He was treated with steroids with partial renal recovery. Patient 2 An 82 year-old man was diagnosed with a locally advanced nasal melanoma. He was treated with pembrolizumab. He was referred to the emergency room 73 days after pembrolizumab initiation presenting acute renal failure. Immunological tests were negative and ultrasonography was normal. No other ATIN-related drugs were identified. The final diagnostic was ATIN confirmed by kidney biopsy and the patient was treated with steroids. ICI was discontinued and the recovery of the kidney function was partial. Six months later he was diagnosed with septic arthritis on his right wrist due to Pseudomonas aeruginosa. 7 days after ciprofloxacin prescription he presented AKI. The diagnosis was a flare of interstitial nephritis, thus oral steroids were re-initiated. Kidney function partially recovered. Patient 3 A 63-year-old woman was diagnosed of renal cancer diagnosed in 2014. She was initially treated with Sunitinib, but it was discontinued due to hypothyroidism. She initiated second-line treatment with Nivolumab 7 months before referral to our nephrology unit. Baseline creatinine was normal. 5 days before referral, she took 3 pills of ibuprofen 600mg during three days due to knee pain. The final diagnostic according to kidney biopsy was ATIN. ICI and NSAIDs were discontinued and she was treated with steroids. Kidney function was totally recovered. Conclusion ICI associated ATIN present scarce temporal association with the initiation of ICI. High prevalence of use of other ATIN-related drugs has been noticed among these patients. Herein, we report 3 cases of ATIN in the setting of the treatment with ICI. The temporal association of the first episode with other drugs rather than ICI, and the relapse after the rechallenge with a drug classically associated with ATIN suggests that it might be caused by these drugs rather than by ICI itself, that actually may facilitate the drug hypersensitivity reaction. Research in the pathomechanisms of ATIN in ICI patients is required in order to anticipate, prevent and treat this adverse effect.

Melanoma of nasal cavity. Literature review and clinical case report

Primary malignant melanoma of the nose mucosa is a rare disease and seen in less than 0,5–0,7% among all melanomas, but has a worse prognosis because of its aggressiveness compared with that of the cutaneous form. Most of the nasal melanomas are not detected in early stage and survival statistics have not improved over the last years. The incisional biopsy is contraindicated, as this may increase metastatic spread. Cytology is definitely a simpler and safer method of getting a quick diagnosis.&#x0D; Most melanomas of nasal mucosa were found when infiltrating muscle, cartilage, or bone, that's why craniofacial resection remains the «gold standard» for these tumors, but and endoscopic resection of sinonasal mucosal melanoma (at limited tumors) has comparable outcomes to open approaches.&#x0D; In report review the relevant medical literature (clinic, classification, histology, treatment and survival) and case observation of patient with primary nasal malignant melanoma.

Local and disease control for nasal melanoma treated with radiation and concomitant anti-programmed death 1 antibody.

Mucosal melanoma of the nasal cavity is a rare disease that has been consistently associated with poor outcome. While complete surgical excision offers the only prospect of a cure, it is associated with a high risk of surgical morbidity due to the challenging anatomical location, and most patients still develop incurable metastatic disease. The efficacy of immunotherapy on mucosal melanoma is lower in comparison with cutaneous melanoma, and mucosal melanoma rarely has BRAF mutations. Although preclinical data have shown that combination treatment with immune checkpoint inhibitors and radiotherapy (RT) improve the response, there have been few reports on the combination of RT and anti-programmed death 1 therapy for mucosal melanoma of the nasal cavity. We retrospectively investigated 10 cases of mucosal melanoma of the nasal cavity in which combined treatment was applied. The local control (LC) rate of the primary lesion and regional lymph nodes was favorably 100%. On the other hand, the median progression-free survival (PFS) time was 29.6weeks (range, 2-82). The 6-month PFS rate was 60%. Although severe mucositis occurred in one patient, the incidence of treatment-related adverse events was not significantly increased. RT with anti-programmed death 1 antibody therapy for mucosal melanoma of the nasal cavity was tolerable and had the potential to improve LC and PFS.

Sino nasal melanoma of nasal cavity: a case report

&lt;p class="abstract"&gt;Sino-nasal melanoma is a rare, recurrent aggressive tumour among head and neck cancers. Nasal obstruction and recurrent, painless epistaxis are commonly reported symptoms seen in old aged individuals. The symptoms are non-specific and tend to delay the diagnosis resulting in poor prognosis. We report 80 year old male patient who presented with recurrent, painless epistaxis from the left nasal cavity with nasal obstruction. Anterior rhinoscopic examination revealed bluish black proliferative bleeding mass completely filling left nasal cavity. Contrast enhanced computed tomography showed a polypoidal soft tissue attenuation with heterogeneous enhancement completely filling left nasal cavity. Patient underwent endoscopic excision. Histopathology of specimen showed small round blue cell tumour, suggestive of sino nasal melanoma. S100 and HMB 45 were found to be positive on immunohistochemistry. Patient was then subjected to chemoradiation. No evidence of recurrence till date.&lt;/p&gt;

Surgically resected pancreatic metastasis from nasal malignant melanoma: case report and literature review

A 13-mm mass was observed in the pancreatic head of a 70-year-old woman who had undergone melanoma resection in the nasal cavity 10years earlier. Endoscopic ultrasonography (EUS) showed that the mass consisted of multiple hypoechoic nodules. EUS-guided fine needle aspiration and pancreatic juice cytologies revealed neoplastic cells positive for HMB45 and melan-A staining with a few melanin granules, indicating the presence of a metastatic malignant melanoma. These additional stainings were evaluated after surgery. In the surgically resected specimen, the mass had multiple nodule-like structures, some of which were brown colored. Immunocytochemistry and electronic microscopy findings confirmed the diagnosis of malignant melanoma. Microscopic findings were similar to the nasal specimen; therefore, the pancreatic lesion was considered to be a metastasis from the nasal cavity.

EP-1159: Management and treatment outcomes of patients with nasal cavity melanoma from a UK cancer centre

EP-1159: Management and treatment outcomes of patients with nasal cavity melanoma from a UK cancer centre

Risk of other Cancers in Families with Melanoma: Novel Familial Links

A family history of cutaneous melanoma (‘melanoma’) is a well-established risk factor for melanoma. However, less is known about the possible familial associations of melanoma with other discordant cancers. A risk for discordant cancer may provide useful information about shared genetic and environmental risk factors and it may be relevant background data in clinical genetic counseling. Using the Swedish Family-Cancer Database, we assessed the relative risk (RR) for any cancer in families with increasing numbers of first-degree relatives diagnosed with melanoma, including multiple melanoma, and in reverse order RR for melanoma in families of multiple discordant cancers. Close to 9% of melanoma was familial; among these 92% were in 2-case families and 8% in families with 3 cases or more. Cancers that were associated with melanoma, in at least two independent analyses, included breast, prostate, colorectal, skin and nervous system cancers. Other associations included cancer of unknown primary, acute myeloid leukemia/myelofibrosis and Waldenström macroglobulinemia/myeloma. Significant results, which appear biologically plausible, were also obtained for rare nasal melanoma and mesothelioma. Although small samples sizes and multiple comparisons were of concern, many of the above associations were internally consistent and provide new diverse leads for discordant familial association of melanoma.

Pericranial Flap for Inner Lining in Nasal Reconstruction.

The general principle in nasal reconstruction is to reconstruct the 3 layers of skin, cartilage, and mucosa. Reconstructing the inner lining remains a challenge especially when adjacent tissues are not available after tumor resection. The galea and pericranial flaps (PFs) are widely used in anterior skull base reconstructive surgery.We evaluated the use of the PF for the inner nasal lining in an anatomical cadaver study and present its clinical application in patients with benign and malignant tumors of the nose and anterior skull base. Four fresh cadavers were injected with red-colored silicone for determining the pattern of vascularization of supraorbital (SOA) and supratrochlear (STA) arteries of each PF. Four surgical cases (2 nasocranial meningiomas, 1 nasal melanoma, and 1 nasal squamous cell carcinoma) received PF for reconstruction of inner lining. The median distances between the superior orbital rim and the division of the deep and superficial branches of STA and SOA were 8 ± 3.3 mm and 8 ± 3.7 mm, respectively. The maximum measured distance was 11 mm. The SOA provided the longest axial vascularization (70.7 ± 13. 9 mm) compared with STA (35 ± 10.4 mm). Median length of PF for subtotal nasal reconstruction including tip and columella were 70 ± 5 mm and 22.5 ± 3.5 mm, respectively.Three cases were successfully reconstructed with PF up to the distal border of the upper lateral cartilage. In 1 patient, distal necrosis of tip and columella occurred. The blood supply of the PF is mainly based on the SOA arteries. Thus, superficial dissection must end 15 mm above the orbital rim to ensure the survival of the flap. Pericranial flap can be applied for inner lining in combined nasocranial, septal, and nasal defects with extension down to the distal border of the upper lateral cartilage. Vascularization is reliable in flaps up to a length of 70 mm.

P14.08 Neurological complications of emerging targeted therapies

AbstractIntroduction:The development of new biological and immunotherapeutic agents to treat cancer associates unknown neurological toxicities. Crizotinib (Cri), an anaplastic lymphoma kinase and c-ros oncogene 1 hepatocyte growth factor receptor tyrosine-kinase inhibitor, has been approved for the treatment of advanced ALK-positive non-small cell lung cancer. Ipilimumab (Ipi), an anticytotoxic T-lymphocyte antigen-4 antibody, was the first agent to demonstrate improved survival in patients with metastatic melanoma. This report describes a patient treated with Ipi showing a not previously reported neurological adverse event; and a patient treated with Cri showing atypical brain metastases.Patients and methods:Patient 1(P1): 66-year-old male with a history of irresectable nasal melanoma, started on Ipi plus concomitant radiotherapy on September/2015, obtaining a radiological partial response. Two months later he developed progressive cognitive impairment, urinary incontinence and gait difficulties. A neuroaxis MRI revealed multiple acute and subacute subcentimeter ischemic lesions with contrast enhancement and restricted diffusion with diffuse FLAIR signal changes. CSF reported protein elevation, normal glucose and mild lymphocytic pleocytosis without neoplastic cells. Microbiological cultures and PCRs were negative. Echocardiography was normal. Patient 2(P2): 54-year-old non-smoker female with lung adenocarcinoma (EGFR wild-type and ALK translocation) and spinal metastatic disease at diagnosis, started on Cri after failure of first-line treatment with cisplatin plus pemetrexed. After 16 cycles, an increase in carcinoembryonic antigen was noted without progression of ganglio-pulmonary disease. Although asymptomatic, CNS progression was suspected and follow-up brain MRI reported multiple bilateral supra and infratentorial large cystic lesions with perilesional edema and no contrast enhancement.Results:P1: primary angiitis of the CNS was suspected, although arteriography was unremarkable. He received high-dose metilprednisolone followed by cyclophosphamide bolus. The inflammatory component of CSF and neurological symptoms presented partial improvement but brain MRI showed a dissociate response. P2: PET scan revealed irregular distribution of the radiotracer and hypometabolic lesions. Follow-up brain MRI revealed stabilization with a perfusion-weighted sequence reporting an increase in the relative cerebral blood volume of the bigger cystic lesion. These features led us to the diagnostic of indolent brain metastases.Conclusions:Early recognition of new neurological patterns of toxicity may lead to drug discontinuation or dose adjustment preventing further neurological deterioration. A better knowledge of these toxicities will help differentiate treatment-related complications from metastatic progression.

Shaggy Photoreceptors with Subfoveal Fluid Associated with a Distant Choroidal Melanoma

Purpose. To describe the enhanced depth imaging optical coherence tomography (EDI-OCT) findings in a patient with an extra macula choroidal melanoma before and after treatment. Methods. Observational case report. Results. A 45 year-old Caucasian male patient was referred to retina clinic for management of choroidal melanoma. Examination revealed a nasal choroidal melanoma while EDI-OCT illustrated subfoveal fluid pocket with elongated shaggy photoreceptors distant and separate from the tumor. The patient was treated with plaque brachytherapy and intravitreal bevacizumab. One week after plaque removal, there was a dramatic reduction in the shaggy photoreceptors. Conclusion. Choroidal melanomas have effects that are not localized to the area of the tumor. This loculated pocket of subretinal fluid and coinciding changes to photoreceptor morphology may be related to global changes in choroidal function or release of tumor related cytokines.

Primary nasal mucosal melanoma in Brazil: clinicopathologic and immunohistochemical study of 12 patients

Primary nasal melanoma is a rare tumor of unknown etiopathogenesis that occurs in adult and elderly patients usually diagnosed at advanced stages. The aim of this study was to analyze the clinicopathologic and immunohistochemical characteristics of 12 cases of primary nasal melanomas in Brazil. Twelve cases of primary nasal melanoma were analyzed histologically and by immunohistochemistry using the antibodies S-100 protein, HMB-45, Melan-A, CD63 (NKI/C3), CD68/KP1, fatty acid synthase (FASN), and Ki-67. The mean age of the patients was 60 years, and 7 of 12 patients were men. Microscopically, 10 cases presented level III of invasion; 4 were amelanotic; and in 7, cells were epithelioid. S-100 protein and FASN were positive in all cases, whereas 9, 8, 7, and 6 cases were positive for HMB-45, Melan-A, CD63 (NKI/C3), and CD68/KP1, respectively. Ki-67 labeling index ranged from 11.45% to 28.5% of positive cells. S-100 protein is more frequently expressed in nasal melanomas than in HMB-45, Melan-A, CD63 (NKI/C3), and CD68/KP1. FASN seems to be involved in the pathogenesis of nasal melanomas, and also, it can be helpful to confirm the diagnosis.

Aural metastasis from a nasal malignant melanoma: case report with literature review

To raise awareness of nasal malignant melanoma, a rare tumour, and to highlight the difficulty associated with its optimum management. Case report and literature review. A 71-year-old, Caucasian man was diagnosed with malignant melanoma in the right nasal cavity, after presenting with right-sided epistaxis. He underwent endoscopic medial maxillectomy; histological analysis confirmed that the resection margins were clear. However, within six months he re-presented with a metastatic deposit of malignant melanoma in his right external auditory canal, for which he underwent right temporal bone resection. There was no evidence of distant metastasis on radiological studies. Unfortunately, within a month the tumour recurred in the right nasopharynx. A multidisciplinary team decision was made to offer the patient palliative chemoradiotherapy. Mucosal malignant melanoma of the nose is very rare, and aural metastasis from this primary site has not previously been reported. Optimum management must involve a multidisciplinary team.

Lateral rhinotomy combined with anterior transantral approach for the treatment of large malignant melanoma of the nasal cavity involving the nasopharynx

The authors report a case of nasal malignant melanoma involving the septum, nasal turbinates and nasopharynx which was approached by lateral rhinotomy combined with an anterior transantral approach with excision of the septum and the lateral wall of the nasal cavity for wide exposure of the tumour. Using this technique complete surgical resection of a large nasal malignant melanoma was achieved with minimal morbidity and good aesthetics.

Two cases of malignant melanoma in turbinate and maxillary sinus

Malignant melanomas develop from malignant transformation of melanocytes that are present in the skin and mucosal linings throughout the body. The overall rate of mucosal melanoma is rare and malignant melanomas developing from turbinates or maxillary sinuses are extremely rare. Symptoms of nasal melanoma are generally nonspecific, and patients often fail to seek prompt medical attention. Diagnosis can be confirmed by the immunochemical profile of staining with anti-S100 and HMB-45 antibodies, even in the case of melanin-free pigment melanoma. The present study reports two cases of primary malignant melanoma in the turbinate and maxillary sinus.

鼻腔悪性黒色腫症例に対する硼素中性子捕捉療法

Malignant melanoma developing in the mucosa of the nasal cavity and paranasal sinuses is rare and has an unfavorable prognosis. We report the clinical course of the first case treated by boron neutron capture therapy (BNCT) for nasal malignant melanoma and discuss several advantages of BNCT. The patient was a 55-year-old man with nasal malignant melanoma complaining of right nasal bleeding. He underwent a pre-irradiation CT scan for treatment planning that was performed with the “JCDS” software program. The tumor was irradiated at the Japan Atomic Energy Agency Research Reactor No. 4 (JRR4) with epithermal neutrons at 3.5MW for 44 minutes. The tumor dose and normal tissue dose calculated ranged from 16.0 to 21.2Gy and from 6.8 to 9.5Gy, respectively. There has been continuous complete regression in the tumor and no acute and chronic complications for 8 months up to the present. Although only one patient has shown a complete regression and additional long-term follow-up should be performed to assess this treatment, we believe that nasal malignant melanoma is suitable for BNCT and that such excellent results will have a great impact on patients in the near future.

Melanoma of the nose.

Melanoma of the nose is rare and management guidelines are poorly defined. In the past, excision margins have often been much narrower than for melanoma elsewhere. The study was a retrospective clinicopathological study of 34 patients with cutaneous melanoma of the nose treated in a single unit. Desmoplastic neurotropic melanoma and lentigo maligna melanoma were the most common histological tumour types. Local recurrence occurred in eight patients, and in six cases appeared to be a result of inadequate excision margins. Regional lymph node metastases were associated with a very poor prognosis. Adequate surgical excision is the mainstay of successful treatment for melanoma of the nose. Excision margins for nasal melanoma should not be any less than for melanoma elsewhere. Careful planning is required, not only to gain local disease control and the best chance of cure, but also to achieve functionally and aesthetically acceptable results. Excision margins need not be compromised in view of the variety of local flaps that can be employed to close the primary defect.

Primary malignant melanoma of the nose: a rare cause of epistaxis in the elderly

We report the case of a primary nasal malignant melanoma in an elderly woman, illustrating the dilemmas involved in clinical decision making with non-specific symptoms, and the treatment of cancer in elderly patients. We also discuss the incidence, clinical presentation, diagnosis, principles of management and outcome.