What are the signs and symptoms of a malignant nasal mass?

Signs and Symptoms of Malignant Nasal Mass

Persistent nasal obstruction or congestion, epistaxis (nosebleeds), and unilateral symptoms are the most concerning signs of a malignant nasal mass and warrant immediate referral to an ENT specialist for evaluation. 1

Cardinal Symptoms

Malignant nasal masses often present with a combination of the following symptoms:

Primary Symptoms

• Nasal obstruction/congestion (most common symptom, often unilateral and progressive) 1, 2
• Epistaxis (recurrent nosebleeds, often unilateral) 1, 2
• Rhinorrhea (unusual nasal discharge, possibly blood-tinged) 1, 3
• Anosmia/hyposmia (reduction or loss of smell) 1

Advanced Disease Symptoms

• Facial pain or pressure (particularly when involving sinuses) 1
• Proptosis (bulging of the eye) 1
• Diplopia (double vision) 1
• Facial swelling or asymmetry 1
• Trismus (difficulty opening mouth) 1
• Cranial nerve dysfunction (particularly I/VI) 1
• Unexplained tooth mobility or ill-fitting dentures 1

Distinguishing Features of Malignancy

Several features help differentiate malignant from benign nasal masses:

• Unilaterality - Malignant lesions are often unilateral, while inflammatory conditions like chronic rhinosinusitis typically affect both sides 1, 3
• Progression - Symptoms that worsen progressively over time despite appropriate treatment 2
• Persistence - Symptoms that don't respond to standard treatments for rhinosinusitis 1
• Blood-tinged discharge - Especially when unilateral 2, 4
• Late-stage symptoms - Facial numbness, swelling, or visual changes suggest invasion of surrounding structures 1

Red Flags Requiring Urgent Evaluation

• Unilateral symptoms that persist for more than 3 months 1
• Orbital involvement (proptosis, diplopia, visual changes) 1, 5
• Cranial nerve deficits 1
• Facial deformity or swelling 1
• Unexplained weight loss or fatigue accompanying nasal symptoms 1

Epidemiology and Risk Factors

Malignant nasal tumors are rare, comprising only about 3% of head and neck cancers 1. They affect males more frequently than females (2.8:1 ratio) with peak incidence in the 6th decade 2. Common types include:

• Squamous cell carcinoma (most common epithelial malignancy) 1, 2
• Malignant melanoma 2
• Adenocarcinoma (associated with wood dust exposure) 1, 3
• Olfactory neuroblastoma 6, 5
• Lymphoma 2

Diagnostic Approach

When a malignant nasal mass is suspected:

1. Nasal endoscopy is essential for direct visualization 1, 7
2. Biopsy is required for definitive diagnosis 1
3. Imaging (CT and/or MRI) is necessary for staging 1, 3
4. Chest imaging to evaluate for metastatic disease in advanced cases 1

Important Considerations

• Symptoms of nasal malignancy often overlap with benign conditions, leading to delayed diagnosis 1
• Pain is generally absent until there is skull base or nerve involvement 1
• Due to symptom overlap with common conditions, malignant nasal tumors are often large at presentation 1
• Juvenile angiofibroma (benign but locally aggressive) should be suspected in adolescent males with a vascular posterior nasal mass - biopsy should NOT be performed due to risk of hemorrhage 1

Early detection is critical for improving survival outcomes, as 5-year survival rates vary significantly by stage and histology, ranging from approximately 30-60% 2, 5.