Sinonasal mucosal melanoma presenting with ocular symptoms: Two case reports and a literature review

Purpose Sinonasal mucosal melanoma (SNMM) accounts for approximately 4–8% of sinonasal malignancies. SNMM frequently originates in the nasal cavity, causing nonspecific nasal symptoms that inevitably delay diagnosis. Left untreated, the tumor may extend into the orbit. Case Description Herein, the authors describe two patients presenting with compressive optic neuropathy and were found to have advanced SNMM involving the orbit. Both patients presented with vision loss, decreased color vision, proptosis, conjunctival chemosis, and restricted extraocular movements. One patient was found to have a relative afferent pupillary defect. Neither patient was a surgical candidate, and both received palliative radiotherapy and immunotherapy. Conclusions These cases and literature review demonstrate the potential for the disease to initially manifest with orbital extension and ocular symptoms. Ophthalmologists can play a crucial role in the early detection of SNMM, which may improve outcomes, given the challenges of SNMM treatment.