Magnetic resonance imaging of nasopharyngeal and paranasal sinus melanoma

Malignant melanoma of the nasopharynx and paranasal sinuses is relatively rare. We retrospectively reviewed the magnetic resonance appearance of five cases and correlated this with the histopathological appearance. In all cases, the magnetic resonance (MR) images clearly demonstrated the precise anatomic extent of the tumor and were sensitive in assessing intracranial extension and invasion into surrounding structures, including the skull base. Three cases were reviewed for histopathological evidence of melanin, hemosiderin, and acute hemorrhage. One case was reviewed for melanin and hemorrhage only. The findings in this series suggest that melanoma of the nasopharynx and paranasal sinuses have extremely variable amounts of paramagnetic substances, both melanin and products of hemorrhage. T1 shortening appears to be more often a reflection of the paramagnetic effects associated with products of hemorrhage rather than the presence of melanin.