Nasal mucosal melanoma compare to outside MRI post 4 cycles of pembrolizumab . There is an apparent intermediate T2, enhancing mass in the inferior right nasal cavity, which appears to involve the right inferior turbinate. The abnormality is ill-defined and measures approximately 45 mm AP x 15 mm RL x 15 mm SI. There may be extension of abnormality into the right medial maxillary sinus and/or focal adjacent mucosal thickening. The rest of the paranasal sinuses are unremarkable. There is associated narrowing of the inferior portion of the right nasolacrimal duct, while the upper right nasolacrimal duct and sac are distended. There appears to be layering debris with in the lacrimal sac. There is also a nodule in the left lateral rectus muscle that measures up to 12 mm. There is nasopharynx and left nasal cavity are intact. The imaged intracranial structures are unremarkable.
An apparent mass in the inferior right nasal cavity is compatible with recurrent nasal mucosal melanoma, with associated obstruction of the right nasolacrimal duct. A nodule in the left lateral rectus muscle that measures up to 12 mm is also compatible with metastatic disease. 