A patient with a history of recurrent metastatic conjunctival melanoma presented with a left upper lid orbital lesion and pigmented lesion in the medial fornix. The original conjunctival melanoma was originally excised in an outside center with positive margins. After a few years, the tumor metastasized to the orbit, which was removed. The patient was then started on nivolumab, an immune checkpoint inhibitor. The current lesions were excised with a high clinical suspicion of metastasis. Histopathologic examination demonstrated granulomatous inflammation with no evidence of tumor. These granulomatous lesions may be secondary to the immune checkpoint inhibitor treatment. While granulomatous inflammation has been a documented systemic side effect, it has rarely been reported in the conjunctiva and ocular adnexa.
Presentation Date: 02/02/2023
Issue Date: 02/10/2023