Metastatic melanoma to the ethmoid sinus

Area of Science:

• Oncology
• Otorhinolaryngology
• Pathology

Background:

• Malignant melanomas account for 1.5% of all cancers, with 20% affecting the head and neck region.
• Head and neck surgeons must possess comprehensive knowledge of melanoma in this anatomical area.
• Metastasis to the nose and paranasal sinuses is common, typically involving the maxillary sinus.

Observation:

• The maxillary sinus is the most frequent site for nasal and paranasal sinus metastases, often originating from renal or pulmonary primary tumors.
• Common presenting symptoms include epistaxis, a nasal mass, or nasal obstruction.
• A review of existing literature revealed no documented cases of isolated metastatic melanoma specifically to the ethmoid sinus.

Findings:

• This review identifies the ethmoid sinus as a novel, previously unreported site for isolated metastatic melanoma.
• The findings suggest that the ethmoid sinus can be a solitary site for melanoma metastasis.
• Batson's 1940 hypothesis regarding hematogenous spread via the valveless vertebral venous system provides a potential mechanism for this occurrence.

Implications:

• The identification of the ethmoid sinus as a potential site for isolated metastatic melanoma expands the differential diagnosis for sinonasal masses.
• This finding necessitates increased awareness among clinicians, particularly otolaryngologists and oncologists, regarding the diverse metastatic patterns of melanoma.
• Further research is warranted to elucidate the precise mechanisms and incidence of ethmoid sinus involvement by metastatic melanoma.