Mucosal Melanoma of the Nasopharynx and Eustachian Tube: Case Report and Review

Objective: To present a case of mucosal melanoma of the nasopharynx extending to the eustachian tube, with a focus on treatment approach, and to review the literature on mucosal melanoma of the head and neck, with a focused review of cases involving the nasopharynx and/or eustachian tube.

Patient: A 67-year-old woman was diagnosed with mucosal melanoma of the left nasopharynx extending to the eustachian tube after presenting with a 2-year history of left neck mass. At the time of diagnosis, she was found to have distant metastasis to the liver, consistent with stage IV disease.

Intervention: The patient underwent primary surgical resection including endoscopic nasopharyngectomy and eustachian tube resection, and ipsilateral neck dissection (levels I-V).

Results: The patient was discharged on postoperative day 3 with a very good functional status. Permanent pathology determined that the distal eustachian tube margin was microscopically positive. Six of 29 lymph nodes were also positive for regional metastatic disease. The patient had no evidence of primary site recurrence for 23 months, but then developed suspicion for disease in the middle ear; definitive biopsy has been deferred by the patient. Her metastatic disease has remained stable for 27 months after high-dose interleukin-2 treatment.

Conclusion: The standard treatment approach to head and neck mucosal melanoma is primarily surgical. Resection of mucosal melanoma in the nasopharynx and eustachian tube can present challenges in achieving microscopically negative margins. In addition, most patients with sinonasal melanoma will develop distant disease. However, gross tumor resection with adjuvant treatment has been shown to improve locoregional control.