title: Cutaneous melanoma metastatic to the orbit: review of 15 cases.
abstract: OBJECTIVE
  To describe the clinical features, management, and outcomes of 15 patients with cutaneous melanoma metastatic to the orbit. The authors review emerging treatments for metastatic melanoma and their ocular implications.
  
  
  METHODS
  Retrospective chart review of 15 patients with orbital metastasis from cutaneous melanoma.
  
  
  RESULTS
  At presentation of the orbital metastasis, systemic metastatic cutaneous melanoma was present in 13 (87%) patients. The mean interval from diagnosis of cutaneous melanoma to orbital metastasis was 40 months (median, 37 months; range, 0-117 months). The most common presenting signs were dysmotility (63%), proptosis (56%), and blepharoptosis (19%). Four patients (25%) presented with pain. Metastasis involved extraocular muscle in 6 orbits (35%), intraconal space in 4 (24%), extraconal space in 7 (41%), and lacrimal sac in 1 (6%). The tumor was unifocal in all cases, unilateral in 13 patients (87%), and bilateral in 2 (13%). The mean tumor basal dimension was 20 × 20 mm and mean thickness was 16 mm. Treatments included complete surgical excision in 1 patient (6%), external beam radiotherapy (EBRT) in 7 (47%), systemic chemotherapy in 8 (53%), and immunotherapy in 5 (33%). Orbital tumor control was achieved in 2 orbits (18%) following focal therapy alone (excision or EBRT), 4 (36%) following systemic therapy alone (chemotherapy or immunotherapy), and 3 (27%) following combination focal plus systemic therapy. Three patients required exenteration. Survival rates at 1 year/2 years were 100%/0% following focal therapy, 50%/25% following systemic therapy, and 100%/66% following combination therapy.
  
  
  CONCLUSIONS
  Cutaneous melanoma metastatic to the orbit tends to involve muscle (35%) or intraconal soft tissue (24%) as a painless (75%), circumscribed (87%) mass. Treatment with systemic chemotherapy and/or immunotherapy resulted in orbital tumor control in 80% of cases. Overall survival was 25.1 months.
authors.affiliation: *Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut; and †Ocular Oncology Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Greene
authors.forename: David R
authors.initials: DR
authors.lastname: Shield
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
authors.forename: Javier J
authors.initials: JJ
authors.lastname: Servat
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Lin
authors.forename: Alexzandra M
authors.initials: AM
authors.lastname: Douglass
authors.forename: Enzo A
authors.initials: EA
authors.lastname: Fulco
authors.forename: Flora
authors.initials: F
authors.lastname: Levin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017234:Eye Evisceration; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009918:Orbital Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D061766:Proton Therapy; D011878:Radiotherapy; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome