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Mucosal melanoma is an aggressive Malignancy arising from melanocytes in mucosal membranes. Sinonasal mucosal melanoma accounts for approximately 1% of all melanomas and 4% of all sinonasal tumors. Unlike cutaneous melanoma, its etiology remains unclear, and it is often diagnosed at an advanced stage owing to nonspecific symptoms, leading to poor prognosis.

We present the case of an 80-year-old African female with nasal obstruction and recurrent epistaxis for 6 months. Clinical examination and imaging revealed an enhancing soft tissue sinonasal lesion with osseous destruction. Functional endoscopic sinus surgery was performed for tumor debulking, and histopathological analysis confirmed mucosal melanoma with immunohistochemical positivity for HMB45. Despite surgical intervention, the patient was placed on home care owing to the aggressive nature of the disease and limited treatment options. Imaging confirmed local invasion but no distant metastases.

Sinonasal mucosal melanoma is an aggressive entity requiring early diagnosis and multimodal management. Surgical resection remains the primary treatment, but novel therapeutic strategies, including immune checkpoint inhibitors, are needed to improve patient outcomes.