Mucosal melanoma · nose and sinuses

Sinonasal mucosal melanoma

A rare tumour of the nasal and paranasal mucosa. Unilateral obstruction or recurrent epistaxis is not specific for melanoma, but persistent symptoms warrant ENT assessment.

ExaminationENT + endoscopy

Local stagingMRI/CT according to anatomy

Systemic stagingincluding distant disease

Endoscopic image of pigmented sinonasal mucosal melanoma — **Endoscopic appearance**Pigmented tumour in the nasal cavity.Source · CC BY 4.0

Symptoms

What may bring a patient to ENT

Persistence, unilateral symptoms and progression matter more than any single nonspecific symptom.

Nasal obstruction

Especially persistent and unilateral.

Epistaxis

Recurrent or unexplained bleeding deserves assessment.

A mass

May be pigmented or amelanotic.

Later local symptoms

Depend on extension into sinuses, orbit or skull base.

Real imaging

Endoscopy → CT → pathology

A case report does not define a treatment standard, but it can clearly illustrate the diagnostic pathway.

Endoscopy of sinonasal melanoma — **Endoscopy**Pigmented tumour with evidence of bleeding.Source · CC BY 4.0

CT of sinonasal melanoma — CTLocal extent shown in three planes.Source · CC BY 4.0

Histology of sinonasal melanoma — **H&E**Morphologic component of diagnosis.Source · CC BY 4.0

Immunohistochemistry of sinonasal melanoma — **Immunohistochemistry**Immunophenotypic confirmation of melanocytic differentiation.Source · CC BY 4.0

REFCOR 2026

What matters after confirmation

This site now has a dedicated contemporary consensus and should not simply be forced into a cutaneous melanoma algorithm.

ExtentLocal and systemic staging are required during initial planning.

SurgeryFor resectable disease, aim for complete oncologic resection while accounting for critical structures.

RadiotherapyPostoperative radiotherapy is an important component of local-control strategy in the current sinonasal pathway.

Clinically N0 neckProphylactic treatment is not routinely recommended by REFCOR.

Molecular testingREFCOR recommends assessment of NRAS, BRAF and KIT.

Core source: 2026 REFCOR practice guidelines for sinonasal mucosal melanoma. Individual decisions require specialist MDT review.