Nasal Mucosal Melanoma

鼻黏膜黑色素瘤

范釗銘(Chao-Ming Fan) ； 鄭博文(Po-Wen Cheng) ； 羅武嘉(Wu-Chia Lo)

《台灣耳鼻喉頭頸外科雜誌》 50卷3期 (2015/09) Pp. 191-195

https://doi.org/10.6286/2015.50.3.191

摘要

鼻腔及鼻竇之黏膜惡性黑色素瘤是一種相當罕見且侵襲性高的腫瘤，病人常常主訴單側鼻塞及鼻血，如同本案例，它最常發生於鼻腔側壁及鼻中膈，而這位病人的原發部位在鼻腔且有下鼻甲侵犯。帶有黑色素的惡性黑色素瘤較易診斷，然而不帶有黑色素的惡性黑色素瘤則常常不易診斷，因此，確切診斷常需依靠一系列的免疫組織化學染色。因為此疾病侵襲性高且預後不佳，因此依據AJCC第七版的分期，其原發部位並未有第一期及第二期的診斷。帶有廣泛安全範圍的手術切除仍為目前治療的基石，輔助放射線治療可能可以增進疾病的原發以及局部控制率。常見影響病人存活率的因素包括腫瘤切除不完全、腫瘤發生部位不易手術及腫瘤體積過大。此案例接受了內視鏡鼻腔腫瘤切除手術，之後又接受了內側上頜骨切除手術來確認並無殘存的黑色素瘤。目前鼻黏膜惡性黑色素瘤的5年存活率仍差，然而這位病人追蹤至今4年尚無復發。

關鍵字

黏膜黑色素瘤 ； 鼻腔 ； 鼻血 ； 鼻塞

並列摘要

Mucosal malignant melanoma of the nasal cavity and paranasal sinuses is a rare but very aggressive neoplasm. It's frequently presented with unilateral nasal obstruction and epistaxis, like the present case. In the majority of patients, nasal mucosal malignant melanoma arises from lateral nasal wall or the septum. In our patient, the tumor arose from nasal cavity with invasion of inferior turbinate. The diagnosis may be easy in melanotic malignant melanoma but more difficult when melanin is absent. As a result, a series of immunohistochemical profile of malignant melanoma is needed to make the diagnosis. To reflect this disease's aggressive behavior and poor outcome, no T1 and T2 lesions exist according to the 7th edition of the American Joint Committee on Cancer (AJCC). Complete surgical resection with a wide margin is the cornerstone for sinonasal mucosal malignant melanoma. Adjuvant radiotherapy may reduce the likelihood of local and regional recurrence. Incomplete resection, tumor location, and volume have been reported to be predictors of survival. In this case, she received endoscopic excision of the nasal tumor and then medial maxillectomy to make sure that there was no remnant melanoma. The reported 5-year overall or disease-specific survival is still poor, whereas this patient was still free of disease during a 4-year follow-up.

並列關鍵字

Mucosal melanoma ； nasal cavity ； epistaxis ； nasal obstruction