Nasal cavity, paranasal sinuses, nasopharynx
Other tumors

Author: Nat Pernick, M.D. (see Authors page)

Revised: 23 May 2018, last major update November 2004

Copyright: (c) 2004-2018,, Inc.

PubMed Search: Melanoma[TI] nasal[TI]

Cite this page: Pernick, N. Melanoma. website. Accessed September 21st, 2018.
Definition / general
  • 1% of all melanomas occur in this region, usually in nasal cavity
  • Frequently misclassified
  • Mean age 64 years, range 13 - 93 years, no gender preference, may affect teenagers
  • Established risk factors for cutaneous melanoma of sun damage, family history and atypical nevi do not apply to this region
  • Difficult to diagnose if no intraepithelial component and no pigment
  • Poor prognosis, usually recurs; median survival 3 years; 5 year survival is 35%

Proposed staging:
  • T1 - single anatomic site; T2 - two or more anatomic sites
  • N0 - no nodal metastases; N1 - nodal metastases
  • M0 - no distant metastases; M1 - distant metastases
  • Stage: I - T1 N0 M0; II - T2 N0 M0; III - any T, N1 M0; IV - M1
Case reports
  • Complete excision
Gross description
  • Solid polypoid growth, often pigmented, mean 2 cm
  • Often ulcerated and necrotic
Microscopic (histologic) description
  • Small uniform cells, 70% with pigment
  • 1/3 have junctional component
  • Often nesting growth pattern
  • Other patterns are small blue cell, spindle cell, epithelioid, pleomorphic
  • Frequent vascular and deep tissue invasion
  • Occasionally myxoid or with metaplastic bone
  • May have minimal pleomorphism, prominent spindle cells
  • Rarely has fibrillar background with Homer-Wright rosettes
Microscopic (histologic) images

Images hosted on other servers:

A: gross of hard palate pigmented macular lesion; B: tumor presents as nasal septum polyp
C: hard palate in situ melanoma; D: maxillary antrum melanoma
E: epithelioid melanoma in maxillary mucosa with moderate cytoplasm, pleomorphic nuclei, prominent nucleoli
F: nasal cavity sarcomatoid melanoma with cells resembling vacuolated lipoblasts

A: poorly differentiated / undifferentiated tumor
B: pseudopapillary pattern
C: S100+ only rarely (not typical); D: HMB45+; E: MelanA+
F: tyrosinase+; G: microphthalmia transcription factor+

1: MRI shows large nasal mass involving right maxillary sinus and extending into right orbit, temporal and pterygoid fossa
2: polypoid fragments of respiratory mucosa with submucosal cellular tumor
3: necrosis and angiocentric tumor cells
4: cells have moderate cytoplasm, round nuclei, inconspicuous nucleoli but high mitotic rate

Positive stains
Negative stains
Differential diagnosis