Recurrent mucosal malignant melanoma of the nasal cavity, paranasal sinus and nasopharynx and atypical melanocytic hyperplasia (mucosal melanoma in situ?)

We report on a patient who at 61 years of age presented with two nodular me lanomas in the right nasal cavity. These tumors were limited to the mucosal membrane and were accompanied by a large amount of atypical hyperplasia of the melanocytes within the glandular and surface epithelium of various oth er samples of the mucous membrane, a finding also verified immunohistochemi cally. These tumors were treated surgically. In the clinical course, after a prolonged tumor-free interval,a malignant melanoma of the contralateral n asal cavity occurred, in addition to recurrences in the area of the primary tumor. It seems likely that the large, diffuse proliferation of atypical m elanocytes observed could have been the starting point of both the tumor re currences and the second primary. Thus, in a histologically proven melanoma in the mucous membranes of the upper respiratory system, a more intense pr eoperative histological diagnostic procedure, in given cases with the assis tance of immunohistochemical methods, could be useful to demonstrate intrae pithelial atypical melanocytes. It is possible that by doing this the prese nt poor prognosis for mucosal melanomas of the upper respiratory tract migh t be improved.