Epiglottic melanosis

Excerpt

A 50-yr-old female with a sinonasal melanoma was scheduled for elective endoscopic anterior craniofacial resection with intraoperative computed tomography (CT) imaging to help guide surgical management. A magnetic resonance imaging of the patient’s head six weeks earlier showed locally advanced mucosal melanoma of the left nasal cavity with skull base and nasopharyngeal extension. Preoperative staging scans showed no evidence of metastatic disease, and the decision was made to proceed with conservative resection of all mucosal involvement. Apart from anemia from recurrent epistaxis, the patient had no other significant comorbidities. A rapid sequence induction was performed using fentanyl, propofol, and succinylcholine, and anesthesia was maintained with sevoflurane. Video laryngoscopy (VL) was performed (and recorded) using a GlideScope^® (Verathon, Bothell, WA, USA). Unanticipated extensive melanosis of the epiglottis and larynx were noted on laryngoscopy (Figure). Upon careful review of the VL recording with the surgeons, a further CT scan of the patient’s head and neck was performed prior to commencing surgery. The additional CT imaging showed intracranial and intraorbital progression. Taken together with the laryngeal findings, the surgery was abandoned in favour of palliative radiotherapy.

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