Caucasian male, 53 years old, with no significant past history, who started in February 2007 with left nasal obstruction and epistaxis. He consulted in June for a bluish tumour in the left nostril visible through the nostril. A surgical biopsy of the mass was performed and reported as "nodular melanoma". Computed axial tomography (CT) showed a tumour displacing the septum and extending to the left ethmoid cells. No adenomegaly was palpable in the neck and regional and distant pathology was ruled out by imaging (CT) and laboratory studies.

He underwent surgery in August 2007. The first surgical manoeuvre was a cervicotomy to ligate the left external carotid artery in order to minimise intraoperative haemorrhage. An intraoperative freeze biopsy was performed on a lymph node found isolated in the carotid bifurcation during the arterial ligation manoeuvre described above. The biopsy was reported as negative. A horizontal rhinotomy was continued with section of the columella and vertical section of the upper lip. The bony and cartilaginous septum was resected by advancing the chisel parallel to the hard palate. The en bloc resection of the septum was completed with the tumour originating in the left inferior turbinate. Once the resection was completed, a persistent tumour of 5 mm in diameter was found at the level of the lamina cribrosa of the ethmoid, which was not resected due to the lack of neurosurgical equipment. The wound was sutured in planes, after packing the surgical site with gauze. The patient evolved with paralysis of the left common ocular motor nerve, which resolved spontaneously in 3 weeks.
Pathological anatomy: the deferred study reports: infiltrative epithelioid mucosal melanoma with areas of melanoma in situ. Incomplete resection of the upper margin. Cervical lymph node with melanoma infiltration.

Radiotherapy with three-dimensional reconstruction (6,500 cGy) and 6 cycles of chemotherapy with dacarbazine were indicated. The evolution was favourable and there was no evidence of disease after a 4-year follow-up.

