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Recurrent epistaxis leading to diagnosis of primary sinonasal melanoma
  1. Karine Tawagi,
  2. Rita Akaraz-Avedissian,
  3. Irina Burman-Solovyeva
  1. Internal Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, USA
  1. Correspondence to Dr Karine Tawagi, karine.tawagi{at}


A 48-year-old man presented to urgent care with recurrent epistaxis over 6 months. Initially, nosebleeds were controlled with packing or cautery. Ultimately, he was referred to ear, nose and throat department and underwent nasal endoscopy which revealed polypoid tissue. A biopsy of the polyp showed non-specific inflammation with no evidence of malignancy. Follow-up maxillofacial CT revealed a large mass lesion in the right maxillary sinus, right nasal fossa, much of the ethmoids and right sphenoid, with destruction of adjacent bony structures. MRI revealed a mass in the right nasal cavity with extension into the ethmoid and anterior sphenoid sinus, anterior cranial fossa and medial orbits. Staging CT discovered metastatic disease in the adrenal glands and lymphadenopathy in the neck. The patient underwent endoscopic sinus surgery with debulking and tissue diagnosis of malignant melanoma. He completed radiation therapy to sinus and was subsequently enrolled in a clinical trial. Most recent imaging revealed complete metabolic response on positron emission tomography.

  • ear, nose and throat/otolaryngology
  • head and neck cancer
  • skin cancer
  • oncology
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  • Contributors IB-S: conception or design of the work. KT, RA-A, IB-S helped in data collection. KT: drafting the article. KT and IB-S: critical revision of the article. All the authors gave the final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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