A 53-year-old Caucasian man with no significant past medical history who began in February 2007 with left nasal obstruction and epistaxis.
She consulted in June for a blue tumor in the left nasal fossa, visible in the nostril.
A surgical biopsy of the mass was performed and reported as "nodular melanoma".
Computed tomography (CT) showed a tumor extending the septum to the left carotid arteries.
No neck lymphadenopathy was detected and regional pathology was ruled out by imaging studies and laboratory tests.
1.
Surgery was performed in August 2007.
The first surgical maneuver was a cervicotomy to ligate the left external carotid artery in order to minimize intraoperative bleeding.
Intraoperative frozen section biopsy of a lymph node isolated from the carotid bifurcation was performed during the maneuver of the arterial ligation described.
She was informed as negative.
A horizontal rhinotomy was performed with sectioning of the columella and vertical section of the upper lip.
The bony and cartilaginous septum was resected advancing with the scopol parallel to the hard palate.
En bloc resection of the septum was completed with the tumor originating in the left inferior turbinate.
After the resection, a tumor persistence of 5 mm in diameter at the level of the cribriform plate of the ethmoid was found, which was not resected because the Neurosurgery team was not available.
The wound was sutured by planes, after packing of gauze from the surgical bed.
The patient presented with left common motor nerve palsy, which resolved spontaneously within 3 weeks.
Pathological Anatomy: The study reports mucocutaneous melanoma with areas of melanoma in situ.
Incomplete resection in the upper margin.
Cervical ganglion with melanoma.
1.
Radiotherapy was indicated with three-dimensional reconstruction (6,500 cGy) and 6 cycles of chemotherapy with dacarbacin.
The evolution was favorable and there is no evidence of disease after a 4-year follow-up.
