PT  - JOURNAL ARTICLE
AU  - Karine Tawagi
AU  - Rita Akaraz-Avedissian
AU  - Irina Burman-Solovyeva
TI  - Recurrent epistaxis leading to diagnosis of primary sinonasal melanoma
AID  - 10.1136/bcr-2017-219832
DP  - 2018 Feb 16
TA  - BMJ Case Reports
PG  - bcr-2017-219832
VI  - 2018
4099  - http://casereports.bmj.com/content/2018/bcr-2017-219832.short
4100  - http://casereports.bmj.com/content/2018/bcr-2017-219832.full
AB  - 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.