FIG 4. Patient 5, a 70-year-old woman with a history of desmoplastic melanoma involving the right nose, presents with right-sided facial pain.

A, Contrast-enhanced axial T1-weighted image (600/11/2) with fat saturation demonstrates a soft tissue mass in the right Meckel’s cave and cavernous sinus. There is enhancement of the right temporalis muscle secondary to denervation change (arrow).

B, A more inferior contrast-enhanced axial T1-weighted image (600/11/2) with fat saturation demonstrates a soft tissue mass enlarging the right foramen rotundum (arrow). In addition, there is questionable spread along the GSPN (arrowhead).

C, A more inferior contrast-enhanced axial T1-weighted image (600/11/2) with fat saturation demonstrates involvement of the foramen ovale, which is enlarged and shows abnormal enhancement (arrow). The patient received gamma knife radiosurgery to the right skull base and adjacent soft tissues and improved symptomatically. One year after treatment, however, the patient had interval progression of disease to involve CNs III–XII on the right, and a follow-up MR was performed.

D, Contrast-enhanced axial T1-weighted image (600/11/2) with fat saturation demonstrates an enhancing soft tissue mass (arrow) at the level of the root entry zone of right CN V.

E, A more inferior contrast-enhanced axial T1-weighted image (600/11/2) with fat saturation shows progression in the right cavernous sinus/Meckel’s cave region, as well as clear-cut enhancement of the right GSPN (arrow), with enhancement now extending into the distal right internal auditory canal (arrowhead).