Nasal mucosal melanoma as a cause of epistaxis

A 43-year-old woman presented with an 8-week history of fatigue and recurrent right sided nasal bleeds progressing to significant pain and swelling on the right side of her face. Clinical examination revealed a friable mass in her right nasal passage. A biopsy and staging positron emission tomography-CT scan confirmed the diagnosis of a T4 N1 M1 BRAF wild type mucosal melanoma. The melanoma had metastasised to the right paranasal sinuses, right and left neck nodes, right submental node, right upper breast, liver, the subcutaneous fat of the left buttock and the right iliac bone as well as cerebral metastasis with further disease progression. Combination immunotherapy was started but initially suspended due to an adverse reaction to nivolumab and restarted in due course. Surgical debulking was carried out for symptomatic relief. This case report explores the delay in diagnosis of mucosal melanoma with its subsequent consequences and the lack of understanding of associated risk factors and optimal treatment.