An occult MRI-negative primary parotid melanoma masquerading as an atypical Bell’s palsy: a surgical case report

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In this case, reported in line with the SCARE criteria, we describe an acute facial palsy, presenting in a similar manner to Bell’s palsy, albeit with minor differences. Although clinical suspicion for malignancy was raised and gold standard serological and radiologic tests were requested, no abnormalities were found preoperatively. However, as a prelude to a planned babysitter procedure, as the facial nerve was explored, multiple masses were found in both the superficial and deep lobes of the parotid gland. This was later proven to be a malignant melanoma tumor. On review of literature, it is evident that although rare, about 1% of parotid cancers can present with facial paralysis as the sole symptom. Rarer still, is the underlying etiology; primary parotid melanoma in this case, which carries a very poor prognosis. On the basis of this, we propose extra vigilance when dealing with such cases and suggest a clinical protocol for use to aid diagnosis and subsequent surgical management.

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