Internal carotid artery rupture successfully rescued after resection of locally advanced mucosal malignant melanoma of the eustachian tube: a case report

Mucosal melanoma of the eustachian tube is a rare and highly malignant tumour. Local radical resection combined with radiotherapy and systemic chemotherapy is a classic treatment strategy for this tumour. The internal carotid artery (ICA) is easily damaged when this tumour is removed. Once the ICA ruptures and causes haemorrhage, it can be fatal. We report a case of mucosal malignant melanoma of the eustachian tube with ICA rupture and haemorrhage in a 62-year-old woman 3 days after resection of the tumour. After successful emergency endotracheal intubation, anti-shock treatment was performed. Further, the ICA was examined using digital subtraction angiography under general anaesthesia and the bleeding site was embolized. The patient recovered uneventfully after surgery and was discharged from hospital without hemiplegia, aphasia, or other intracranial complications. Because of economic reasons, the patient discontinued comprehensive treatment after being discharged from the hospital. Finally, she developed bone and kidney metastases 8 months after surgery and died of distant metastases 1.5 years later. When removing eustachian tube lesions, the ICA must be particularly protected. Once the ICA ruptures and there is postoperative haemorrhage, prevention of airway asphyxia, timely anti-shock treatment, and emergency digital subtraction angiography and vascular embolization are effective treatment methods.

Primary mucosal malignant melanoma of the nasal cavity

<p>Primary mucosal melanoma of the nasal cavity and paranasal sinuses is a very aggressive and rare disease with only about 0.5 % of malignant melanoma arising from the nasal cavity. There are only few reports from India. We report a rare case of sino-nasal mucosal malignant melanoma in a 58 years old female who presented with blackish coloured sino-nasal mass involving right nasal cavity, spontaneous and recurrent epistaxis and obliteration of the right naso-labial fold with occasional pain in the past 10 months. Contrast enhanced computed tomography scan showed a heterogenous mass involving right nasal cavity, right maxillary antrum and right ethmoidal area. A positron emission tomography computed tomography was also done which showed increased uptake in the region mentioned above. Initial biopsy, the mass was diagnosed as malignant melanoma. Total maxillectomy was performed with plan of post-operative radiotherapy.</p>

Anorectal mucosal malignant melanoma

Resumen El melanoma maligno de la mucosa anorrectal es una entidad rara y agresiva (menos del 1% de los tumores anorrectales), y su estrategia ideal de tratamiento sigue causando controversia en la comunidad científica. Tanto es así, que no se han encontrado diferencias significativas entre la resección local extensa y la amputación abdominoperineal. Tampoco parece haber una opción clara a la hora de elegir entre las terapias neoadyuvantes o adyuvantes. En este artículo, presentamos el caso de una paciente de 64 años con un melanoma de la mucosa anorrectal localmente avanzado, en el que se practicó una exéresis local amplia de la lesión con buen control de la sintomatología. Ante la poca evidencia de la superioridad de técnicas más agresivas en el tratamiento de estas afecciones, consideramos prudente la excisión local del tumor para mejoría sintomática del paciente.

Safety and Efficacy of Salvage Neck Dissection Following Carbon-ion Radiotherapy with Chemotherapy for a Patient with Mucosal Malignant Melanoma of Head and Neck

Mucosal malignant melanoma of the head and neck is a rare diagnosis. The safety and efficacy of salvage neck dissection following carbon–ion radiotherapy with concurrent chemotherapy are not well described, and carbon–ion radiation protocols have not been fully developed. A 77 year old woman with crT0N1M0 mucosal melanoma of the head and neck achieved a complete response following initial treatment with carbon–ion radiotherapy and concurrent chemotherapy. She was treated with salvage neck dissection for as a cervical lymph node metastasis 16 months after initial treatment. She experienced neither Clavien-Dindo Grade 3 or 4 postoperative complications nor subsequent recurrence of disease at 3 months following salvage neck dissection. Surgical specimens may be useful for future precision oncology based on the molecular biology of recurrence melanoma with poor prognosis.