Abstract
Objectives:
Sinonasal melanoma is a rare malignancy with a high propensity for regional spread and very poor long-term prognosis. Despite the proven benefit of sentinel node biopsy in cutaneous melanoma there is a paucity of literature utilizing this in sinonasal malignancies. We report the first case of a positive sentinel node biopsy in sinonasal melanoma and perform a literature review on sentinel node biopsy for sinonasal carcinomas.
Methods:
The electronic medical record was used to collect pertinent clinical information.
Results:
Patient was an 83-year-old gentleman who presented with recurrent epistaxis and was found to have a sinonasal melanoma anterior to the left inferior turbinate. No clinical or radiological lymphadenopathy was detected during initial evaluation. Pre-operatively, lymphoscintigraphy was performed with 0.39 mCi of technetium-99. This revealed one sentinel node in the ipsilateral level I and level II cervical basins as well as three sentinel nodes in the contralateral level II cervical basin. Intraoperatively, methylene blue was used to co-localize the sentinel nodes and they were removed and sent to pathology. Frozen section pathology of the left level I sentinel node was positive for melanoma and a select neck dissection was performed during the same operation. Final pathology revealed a 2.5 mm focus of melanoma in the sentinel node and the remaining lymph nodes were negative for tumor.
Conclusion:
Sentinel node biopsy for sinonasal melanoma can provide crucial evidence of regional metastasis prior to overt clinical signs and symptoms. This intraoperative tool has the potential to improve detection of regional metastasis and improve long-term outcomes of this aggressive malignancy.