Metastatic melanoma in the eye and orbit.
OBJECTIVE
Presentation of a large series of patients with metastatic melanoma involving the eye and orbit.


METHODS
Retrospective clinical study.


METHODS
Thirteen cases of metastatic melanoma involving intraocular tissues, 6 cases of metastatic melanoma in the orbit, and 1 case of metastatic melanoma involving both the eye and the orbit, treated in Lausanne between 1986 and 2002, were identified from the computer files of the ocular oncology and orbitopalpebral surgery units of Jules Gonin Hospital.


METHODS
The analysis is based on the demographic data concerning these patients, clinical data concerning the tumor, the treatment applied, the outcome, and the follow-up.


METHODS
Clinical presentation of intraocular and orbital metastasis, interval between primary tumor and ocular metastasis, survival of the patients, evaluation of various therapeutic protocols.


RESULTS
Intraocular metastases (14 cases, 15 eyes) were situated in the choroid in 11 cases (isolated lesion, 6 cases; multiple lesions, 3 cases; diffuse involvement, 2 cases), in the iris and ciliary body in 2 cases, and in the retina and vitreous in 2 other cases. The primary tumor was a cutaneous melanoma in 8 cases, a melanoma of the contralateral eye in 3 cases, a mucosal melanoma in 1 case, and was unknown in 2 cases. The mean interval between the diagnosis of ocular metastases and the patient's death was 8.8 months (range, 1-48 months). The primary tumor in the 7 cases of orbital metastases was a cutaneous melanoma in 5 cases, a uveal melanoma in the contralateral eye in 1 case, and was unknown in 1 case. The mean interval between the diagnosis of orbital metastases and death was 19.7 months (range, 5-48 months). The patients were treated by various protocols. The best results, in terms of both local tumor control and preservation of visual function, were obtained with circumscribed proton beam radiotherapy or external beam irradiation, depending on the site and extent of the tumor.


CONCLUSIONS
Metastatic melanomas to the eye and orbit are rare and generally occur in patients with disseminated metastases during the terminal stages of the disease, with a short life expectancy. Treatment is palliative and, among the various possible treatment options, circumscribed proton beam radiotherapy or global photon beam radiotherapy, at relatively high irradiation doses, seems to achieve the most favorable results.
Zografos
Leonidas
L
University Eye Clinic of Lausanne Jules Gonin Eye Hospital, Lausanne, Switzerland. leonidas.zografos@ophtal.vd.ch
Ducrey
Nicolas
N
Beati
Donata
D
Schalenbourg
Ann
A
Spahn
Barbara
B
Balmer
Aubin
A
Othenin-Girard
Chantal Bornet
CB
Chamot
Line
L
Egger
Emmanuel
E
D000328:Adult; D000368:Aged; D001918:Brachytherapy; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D011882:Radiotherapy, High-Energy; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors; D014604:Uveal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary* / Q000628:therapy; D014625:Vaginal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D014792:Visual Acuity