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.
