Cutaneous Melanoma Metastatic to the Orbit
A patient with a past medical history of Stage IIA cutaneous melanoma, treated with wide local excision and radiation therapy, presented after 12 years of remission with proptosis, pain, diplopia, and decreased vision, unresponsive to antibiotic therapy. She was found to have a complete ptosis, downward and outward displacement of the globe, restricted extraocular movements, anisocoria, and 9mm of relative proptosis of the right eye. Imaging revealed an extraconal lesion centered on the right lateral orbit with heterogeneous contrast enhancement extending along the superior orbital fissure to the orbital apex with probable involvement of the right cavernous sinus. She underwent orbitotomy and biopsy, which revealed amelanotic melanoma. She was referred to medical oncology who recommended further staging imaging, treatment with nivolumab, ipilimumab, and evaluation for radiation of the orbit. Metastatic cutaneous melanoma of the orbit is rare, comprising a small minority of all orbital metastases. This case represents metastasis to the orbit 12 years after primary lesion treatment, far longer than other reported cases of the disease. They can present non-specifically with proptosis, eyelid fullness, pain, extraocular movement restriction, blurry vision, or a palpable mass. Orbital imaging and histopathological analysis is essential for management. Treatment options include surgical excision, chemotherapy, radiation therapy, immunotherapy, or emerging vaccines.
Presentation Date: 09/02/2021
Issue Date: 09/24/2021
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