Chou Ching-Feng, Chin Shy-Chyi, Lee Li-Yu, Chen I-How, Liao Chun-Ta, Huang Shiang-Fu
Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan.
World J Oncol. 2010 Aug;1(4):182-185. doi: 10.4021/wjon236e. Epub 2010 Aug 29.
Nasal cavity is a rare site in melanoma and surgery plays important roles in its treatment. A mucosal melanoma penetrating through the nasolacriminal duct (NLD) into orbit in a patient with multiple co-morbidities poses some difficulties in its management. A 78 year-old man developed epiphora and ocular swelling in recent 1 week in his left eye. He had medical histories of hypertension, diabetes, chronic renal insufficiency and right middle cerebral artery infarction. Physical examination revealed left periorbital swelling, chemosis, lateral gaze impairment and a dark-colored mass in left nasal cavity. Mucosal melanoma was diagnosed by biopsy. Contrast enhanced T1-weighted MRI showed an enlarged hyperdense lesion in left nasal cavity which invades through the NLD and gets into left medial aspect of orbit with involvement of preseptal space and retrobulbar fat. The patient was treated with radiation therapy alone (450 cGY in 13 fractions) with partial response. Lung metastasis occurred 3 months later and the patient was alive with disease for 6 more months.Primary surgical resection has been the treatment of choice for mucosal melanoma. Radiotherapy in our patient was chosen for multiple co-morbidities. Neither local nor regional control was improved by this approach. Palliative chemotherapy in this situation could be the treatment of choice for patient's better quality of life.
鼻腔是黑色素瘤的罕见发病部位，手术在其治疗中起着重要作用。对于一名患有多种合并症的患者，黏膜黑色素瘤穿透鼻泪管（NLD）进入眼眶，这给治疗带来了一些困难。一名78岁男性在最近1周出现左眼溢泪和眼部肿胀。他有高血压、糖尿病、慢性肾功能不全和右大脑中动脉梗死病史。体格检查发现左侧眶周肿胀、结膜水肿、外展受限以及左侧鼻腔有一深色肿物。活检诊断为黏膜黑色素瘤。增强T1加权MRI显示左侧鼻腔有一增大的高密度病变，该病变通过鼻泪管侵入左侧眼眶内侧，累及眶隔前间隙和球后脂肪。该患者仅接受了放射治疗（13次分割，共450 cGY），部分缓解。3个月后发生肺转移，患者带瘤生存6个月。原发性手术切除一直是黏膜黑色素瘤的首选治疗方法。由于该患者有多种合并症，所以选择了放射治疗。这种方法既未改善局部控制也未改善区域控制。在这种情况下，姑息化疗可能是提高患者生活质量的治疗选择。
