{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:40:04Z","timestamp":1756320004728,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,6,24]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:p>A 43-year-old woman presented with an 8-week history of fatigue and recurrent right sided nasal bleeds progressing to significant pain and swelling on the right side of her face. Clinical examination revealed a friable mass in her right nasal passage. A biopsy and staging positron emission tomography-CT scan confirmed the diagnosis of a T4 N1 M1 BRAF wild type mucosal melanoma. The melanoma had metastasised to the right paranasal sinuses, right and left neck nodes, right submental node, right upper breast, liver, the subcutaneous fat of the left buttock and the right iliac bone as well as cerebral metastasis with further disease progression. Combination immunotherapy was started but initially suspended due to an adverse reaction to nivolumab and restarted in due course. Surgical debulking was carried out for symptomatic relief. This case report explores the delay in diagnosis of mucosal melanoma with its subsequent consequences and the lack of understanding of associated risk factors and optimal treatment.<\/jats:p>","DOI":"10.1136\/bcr-2018-228640","type":"journal-article","created":{"date-parts":[[2019,7,13]],"date-time":"2019-07-13T04:25:11Z","timestamp":1562991911000},"page":"e228640","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Nasal mucosal melanoma as a cause of epistaxis"],"prefix":"10.1136","volume":"12","author":[{"given":"Ruqaiyah","family":"Behranwala","sequence":"first","affiliation":[{"name":"Birmingham Medical School, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhagya Harindi","family":"Loku Waduge","sequence":"additional","affiliation":[{"name":"Birmingham Medical School, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bervin","family":"Teo","sequence":"additional","affiliation":[{"name":"Acute Medical Unit, New Cross Hospital, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,12]]},"reference":[{"key":"2025082710590679000_12.7.e228640.1","doi-asserted-by":"crossref","DOI":"10.1002\/(SICI)1097-0142(19981015)83:8<1664::AID-CNCR23>3.0.CO;2-G","article-title":"The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. 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