Anterior rhinoscopy and fibre optic nasolaryngoscopy may reveal blackish-blue, pale yellow, or, in the case of amelanotic melanomas
, translucent polypoid masses .
Differential diagnosis consisted of necrotizing ulcerative gingivitis with facial involvement (noma), leishmaniasis, Wegener granulomatosis, deep fungal infection, and amelanotic melanoma
. Amelanotic melanoma
was ruled out because of a long clinical course of the lesion.
Milky-red areas are vascular structures seen in hypomelanotic or amelanotic melanoma
. Pink veil may be seen in benign lesions, including dermatofibroma, as well as basal cell carcinoma and melanoma .
Specifically, these lesions may mimic urothelial carcinoma on histological evaluation, particularly with cases of hypomelanotic to amelanotic melanoma
.[sup.10] In our case, pathological examination showed a solid lesion that closely mimicked urothelial carcinoma.
We report a case of locally advanced amelanotic melanoma
of the nasal cavity in a 55-year-old woman who presented with complaints of nasal obstruction and intermittent bleeding on the right side of the nose for 3 months and a gradually progressive diffuse swelling over the right periorbital and maxillary areas for 2 months with associated pain for 15 days.
In rare cases, iris sarcoid granulomas can simulate other prominent iris lesions such as an amelanotic melanoma
of the iris or a carcinoma metastasis [6, 7] such as in our case.
Three cases (4.05%, vimentin+, S-100+, HMB45+) of malignant melanoma were diagnosed including one amelanotic melanoma
(HMB45-), one malignant melanoma of soft part (clear cell sarcoma) and one small cell amelanotic melanoma
Other factors associated with poorer prognosis include duration of symptoms > 3 months, tumour perineural invasion, presence of inguinal lymph nodes, and amelanotic melanoma
on histology (2).
The term amelanotic melanoma
is often misused to describe both a melanocytic lesion with minimal residual component or a true amelanotic lesion.
While only 5% of all melanoma cases are not among the major histopathologic subtypes, nearly 11% of the foot cases in the Loyola study were tumor variants, such as spindle cell or amelanotic melanoma
. The delayed presentation and diagnosis of these tumor variants can translate into a higher mortality risk.
is the scariest type and, fortunately, is rare.
Melanoma from unknown primary site and amelanotic melanoma
. Semin Oncol 1982; 9:442-7.
A patient with amelanotic melanoma
may look well, but will likely soon be dead.
 While we do not have such figures for SA, we identified one South African who had used a sunbed prior to the development of an invasive amelanotic melanoma
on her left leg.