Massive extraocular extension and parotid lymph node metastasis of uveal melanoma

A 22-year-old man, diagnosed with unilateral glaucoma and treated with trabeculectomy 6 years earlier, presented with an epibulbar nodule of 6 months' duration. MRI displayed intra- and extraocular tumor, and gross invasion of the medial rectus muscle. Biopsy demonstrated uveal melanoma, and staging revealed enhancing ipsilateral parotid lymph nodes. Orbital exenteration and parotidectomy with selective neck dissection were performed. The tumor infiltrated superficial parotid nodes and extended into the parotid gland. The site of tumor origin is speculative, but a ring melanoma of the anterior chamber angle is suspected. Lymph node metastasis of uveal melanoma is rare; to our knowledge, this is the most advanced of the few reported cases.