Primary malignant melanoma of lacrimal sac is extremely rare and is usually diagnosed late, after excision or biopsy of the tumor. Its current management consists of surgical excision, chemotherapy, radiation therapy, and immunotherapy in various
combinations. We present two cases of malignant melanoma of the lacrimal sac that masqueraded as chronic dacryocystitis. Two patients presenting epiphora and a palpable mass in the medial canthal area underwent surgical excision of the tumor. A
histologic diagnosis of these tumors may be difficult, requiring immunohistochemical or electron microscopic confirmation. Staining with monoclonal antibodies to melanoma antigen (HMB-45) was positive and electron microscopy showed the presence
of
melanosomes and premelanosomes, thus confirming the diagnosis of malignant melanoma. One of the patients, a 56-year-old man, died of distant metastasis six months after surgery and postoperative radiation therapy. The other patient, a 65-year-old
woman,
had no evidence of recurrence or distant metastasis three years after surgery and postoperative radiation therapy. Otorhinolaryngologists should be aware of this disease entity when encountered with patients presenting with epiphora and mass in
the
medial canthal area.
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