Cutaneous malignant melanoma metastatic to the vitreous

We describe a patient with dysplastic nevus syndrome and cutaneous melanoma in whom vitreous involvement was the first sign of metastatic disease. Cytologic examination of vitreous aspirate can usually confirm the diagnosis. Enucleation may be a treatment option if the vitreous is the sole metastatic site.     

Pseudoinflammatory metastatic breast carcinoma of the orbit and lids

A 60-year-old woman presented five years after a radical mastectomy for breast carcinoma, with vague, non-specific complaints referable to the left eye, consisting of ptosis, extraocular motility problems, and irritation, all believed initially to be due to an inflammatory causation. The indurated quality of the involved tissues, coupled with the results of computed tomographic studies, led to the suspicion of the correct diagnosis, namely, metastatic scirrhous carcinoma of the ocular adnexa. Biopsy and electron microscopic studies confirmed this diagnosis. Clinical and pathologic pitfalls in failing to distinguish scirrhous carcinoma from an inflammatory lesion are discussed.     

Immunotherapy for melanoma metastatic to the orbit

PURPOSE: To present 3 cases of melanoma metastatic to the orbit treated with various traditional modalities including surgery and chemotherapy and being treated with melanoma vaccines and to present background information on immunotherapy. METHODS: Retrospective review of 3 patients with melanoma metastatic to the orbit who were treated with melanoma vaccines along with conventional treatments. One patient had known orbital involvement before vaccine treatment; 2 patients had orbital metastases subsequent to vaccine administration. RESULTS: Patients survived at least 13 months after the diagnosis of metastatic melanoma, with 1 patient surviving 51 months after the onset of metastases and administration of melanoma vaccine. CONCLUSIONS: Although still unproven, immunotherapy with melanoma vaccines is a promising new treatment modality for metastatic melanoma with few side effects.     

Metastatic melanoma in the eye and orbit

OBJECTIVE: Presentation of a large series of patients with metastatic melanoma involving the eye and orbit. DESIGN: Retrospective clinical study. PARTICIPANTS: 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. MAIN OUTCOME MEASURES: 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.     

Primary cutaneous malignant melanoma metastatic to the iris.

We describe a case of cutaneous malignant melanoma metastatic to the iris as the first presenting sign of metastases 10 years after excision of the primary tumour. The histology of the excised iris metastases and the primary skin melanoma are compared. Progressive intracranial metastatic growth did not correlate with the observed regression of the residual intraocular melanoma cells during cyclical cytotoxic therapy.     

Attempts of orbit irradiation after enucleation of the eye with malignant choroidal melanoma. Part I

PURPOSE: The problem of orbit irradiation after enucleation of the eye with choroidal melanoma is controversial. We have decided to analyse our own material in order to estimate the effectiveness of this method. MATERIAL AND METHODS: The clinical material comprised 202 patients, 97 women and 105 men, in the age of 15-84 years, whose eyeballs were enucleated because of choroidal melanoma. In 72 patients the orbit was irradiated after enucleation with 60Co applicator (CKA4). The dose was about 50 Gy, 5 mm deep. The height of tumour, its location, histological type, infiltration of the sclera or beyond the eyeball and the treatment of tumour before enucleation were analysed. The follow-up time was 5-20 years. RESULTS AND CONCLUSIONS: The survival time of patients in the age below 30 years (p < 0.05) and of patients with choroidal melanoma of the height above 3 mm (p < 0.01) was significantly longer when the orbit was irradiated. Also the survival time of patients with scleral infiltration and with spindle-cell type of tumour was longer (but statistically not significantly) in those, whose orbits were irradiated after enucleation. Exenteration of the orbit was necessary in 4 cases not irradiated after enucleation, only in 1 case after irradiation. The probability of survival after irradiation of the orbit was significantly higher than in cases not irradiated (0.6971 vs. 0.6219). The estimated mean survival time (in months) was longer, but not significantly, in patients after irradiation of the orbit (197.017 vs. 181.409). We conclude that irradiation of the orbit after enucleation of the eye with choroidal melanoma should be recommended. Further investigations will be continued with collaboration of Institute of Oncology in Cracow.     

Melanoma metastatic to the orbit

Cutaneous malignant melanoma often metastasizes to the lung, bone, liver, subcutaneous tissue, and lymph nodes. Six cases of malignant melanoma metastatic to the orbit are presented, five from cutaneous melanomas and one from a contralateral choroidal melanoma. Melanoma rarely metastasizes to the orbit, but when orbital involvement occurs, widespread metastases are already present. Twenty-two cases were reviewed from the literature; 13 of 14 patients, with sufficient follow-up data, had widespread metastases when they presented with orbital disease. Extraocular muscles appear to be a favored site of metastases. The mean time from orbital presentation to death was 4 months. Orbital metastases from a distant melanoma is, therefore, part of a widespread metastatic process. Treatment should be directed toward palliation.     

Angiosarcoma metastatic to the orbit

A 61-year-old woman developed metastatic angiosarcoma in her left orbit. Diagnosis was confirmed with an incisional orbital biopsy and special markers. Treatment and palliation involved the use of multiple cycles of paclitaxcel, doxorubicin, and ifosfamide along with adjuvant radiotherapy. The measured outcome was tumor mass reduction and mortality. Angiosarcoma was confirmed with histologic analysis. The patient responded to the chemotherapy with reduction of the tumor mass. However, the disease progressed off the medications. She finally died. However, she survived longer than the patient in the only other similar case report. Chemotherapy may be a useful palliative adjunct in the control of metastatic orbital angiosarcoma. Chemotherapy is unlikely to be curative but useful and an adjunct to surgery and radiation therapy.     

Hepatoma metastatic to the orbit

A 69-year-old man with a history of cirrhosis of the liver had unilateral progressive proptosis without jaundice, abdominal pain, or gastrointestinal symptoms. Results of laboratory and radiographic studies were also normal. Orbital biopsy revealed hepatocellular carcinoma. Although hepatocellular carcinoma has often been shown to metastasize to the brain and often to the flat bones of the skull, to the best of our knowledge, this is the first histologically proven case of hepatoma metastatic to the orbit.     

Ganglioneuroblastoma metastatic to the orbit

A 10-month-old girl presented with an extensive orbital and cranial metastatic lesion from an adrenal ganglioneuroblastoma. Treatment with chemotherapy alone resulted in complete regression of the tumors with over 7 years of follow-up. Good prognostic indicators included her young age at diagnosis, DNA index of tumor cells of 1.4, and the histologic subtype of neuroblastic tumor. This is the first reported case of ganglioneuroblastoma metastatic to the orbit.     

Tumors metastatic to the orbit

A review of 35 consecutive cases of tumors metastatic to the orbit revealed that the primary tumor site was breast in 18 cases (51%), prostate in 6 cases (17%), lung in 2 cases (6%), gastrointestinal tract in 2 cases (6%), kidney in 1 case (3%), cutaneous melanoma in 1 case (3%), contralateral choroidal melanoma in 1 case (3%), and unknown in 4 cases (11%). The most common presenting signs and symptoms included diplopia with noncomitant strabismus, proptosis, and a palpable mass. In nine cases (26%), the orbital metastasis was detected in patients with no prior history of cancer. The average patient survival after the diagnosis of orbital metastasis was 13 months. Orbital metastasis from lung carcinoma carried the worst prognosis, with an average survival time of only 4 months. A summary of the clinical features of these 35 cases and a review of the literature on orbital metastatic disease will be presented.