Mucosal Melanoma of the Nasal Cavity

Abstract Background: Mucosal melanoma is a rare variant of melanoma that is more aggressive than the more common cutaneous form. It often presents with nonspecific sinonasal symptoms, leading to delayed diagnosis. Involvement of the nasal cavity accounts for less than 1% of all melanomas. Case Report: We report on 2 elderly female patients whose routine nasal complaints were ultimately diagnosed as nasal mucosal melanoma, highlighting the importance of maintaining a high index of clinical suspicion. The first patient, a 78-year-old woman, presented with nasal congestion and pressure. Initial diagnoses of seasonal allergies and maxillary sinusitis resulted in a 5-month delay before imaging revealed a surgically unresectable tumor. Despite treatment with nivolumab plus relatlimab, followed by ipilimumab plus nivolumab and radiation therapy, she developed metastatic disease and died 11 months after diagnosis. The second patient, a 74-year-old woman, presented with nasal congestion, epistaxis, and nasal obstruction. Biopsy demonstrated spindle-cell mucosal melanoma. She underwent surgical resection with positive margins, followed by adjuvant radiation therapy and sequential immunotherapy but ultimately developed metastatic disease and died 22 months after diagnosis. Discussion: These cases illustrate the diagnostic challenges associated with nonspecific sinonasal symptoms and the aggressive clinical course of nasal mucosal melanoma. Despite multidisciplinary treatment, including surgery, radiation therapy, and immunotherapy, outcomes remained poor, emphasizing the limitations of currently available therapies. Conclusions: Mucosal melanoma of the nasal cavity is a rare and highly aggressive malignancy. Early recognition, prompt imaging, and biopsy are essential to facilitate diagnosis and maximize opportunities for potentially curative treatment. Improved therapeutic strategies are needed to enhance survival in this patient population.