Mucosal melanoma of nasal cavity in 89–year-old woman – case report and review of the literature
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Mucosal melanoma constitutes 1,3–1,4% of all melanomas. 25–50% of these cases occurs in head and neck region. Primary melanoma of the head and neck mucous membranes is most often diagnosed in the nasal cavity (50%), maxillofacial region (20%), oral cavity (17%), and then nasopharynx, casuistic in the larynx. Recurrent nasal bleeding and persistent nasal obstruction are the most frequently presented symptoms. In comparison to skin melanoma, mucosal melanoma is diagnosed 1 decade later and has different etiology. It is usually diagnosed at an advanced stage when metastases are already present. Approximately 20% of patients have metastases to the lymph nodes at diagnosis and 10% distant metastases. Histopathological diagnosis is based on the detection of malanocyte markers: S-100, Melan-A, HMB-4, MITF-1 and vimentin. Mucosal melanoma can be misdiagnosed as olfactory neuroblastoma. In ⅓ of the cases, melanoma of mucous membranes occurs in the amelanotic form. Treatment of choice is radical resection and adjuvant radiotherapy. In the head and neck region radical disscection may be a challenge for operating surgeon because of closeness of anatomical structures and preservation of function. In advanced stadium immunomodulatory treatment can be applied. Overall 5-year survival is estimated for 12–44%. Based on presented case authors note the necessity of inclusion additional factors in geriatric oncology and generally discuss the diagnosis and treatment of mucosal melanoma.
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