Unusual Presentation of Malignant Melanoma in the Nasal Cavity

Background Nasal cavity melanoma is an extremely rare tumor and more aggressive than its cutaneous counterpart. They occur in elderly patients of both genders and are commonly associated with a poor prognosis. Aim To present a case of primary malignant melanoma of the nasal cavity in a 55-year old female and increase the awareness of the general populace of its presentation and management. Case Presentation A 55-year old female house wife presented with six months history of gradual, progressive left nasal obstruction and intermittent epistaxis. Three months prior to presentation she noticed dark coloured nasal growth which completely blocked the left nasal cavity with associated persistent mucopurulent nasal discharge. There was no known co-morbifity. Per nasal biopsy was done under local anaesthesia. Microscopy showed large epithelioid and few spindle cells showing hyperchromatic nuclei, macronucleoli and both intra- and extra-cellular melanin pigments that led to a provisional diagnosis of malignant melanoma. She subsequently had lateral Rhinotomy and was managed accordingly. The patient is doing well 8 months post-operatively. Conclusion Primary mucosal malignant melanoma of the nasal cavity is a sporadic, aggressive tumour with poor prognosis and late detection. The clinical and radiographic features of these tumours are nonspecific, therefore, an accurate diagnosis requires histologic assessment. So, early diagnosis with high index of suspicion is essential for the management of the condition.