Abstract: Objective: To analyze the clinical effect of the modified anterior method in the treatment of the patient with primary malignant melanoma of lacrimal sac, and to improve the clinician's understanding of the disease and operation method. Methods: The clinical materials, imaging founding and pathological data of one patient with primary malignant melanoma were collected, the advantages of the modified anterior lacrimal recess approach in the treatment of the disease were analyzed, and the clinical diagnosis criteria and treatment methods were summarized combined with the relevant literature review. Results: The female patient,aged 53 years old, had tears in her right eye for 2 years and tumor in her inner canthus for 6 months and was admitted to the hospital because of tumor of dacrycyst. The tumor was found in inner canthus of the right eye of the patients, which was about 1.7 cm×1.2 cm×1.0 cm in size, with tough texture, unclear boundary, tenderness, and close adhesion with the surrounding skin; when the lacrimal sac area was squeezed, a little blood secretion overflowed from the lacrimal spot. The lacrimal passage was washed and the flushing fluid was flowed back in the original lacrimal point. The orbital CT results showed high density shadow in the right lacrimal sac, high density shadows in the right lacrimal sac area and nasolacrimal duct, and obvious enlargement of the right lacrimal sac. The primary diagnosis was right lacrimal sac and nasolacrimal duct space occupying lesions. Modified anterior lacrimal recess approach under nasal endoscope was used to remove the tumor completely. The postoperative pathology showed that the malignant melanoma involved in the surrounding muscle tissue. Conclusion: The modified anterior lacrimal recess approach under nasal endoscope has the advantages of good field exposure, minimal invasive surgery, easy to operate and low risk.

Key words: nasal endoscope, modified anterior lacrimal recess approach, lacrimal sac, primary malignant melanoma