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Updated: Apr 30, 2026
Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography
Published on: December 2, 2022
Cutaneous melanoma metastatic to the orbit: review of 15 cases
Daniel P Greene1, David R Shield, Carol L Shields
1*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.
Purpose:
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.
Insights
Orbital metastasis from cutaneous melanoma often presents as a painless mass affecting eye muscles. Systemic therapies like chemotherapy and immunotherapy achieved 80% orbital tumor control, improving overall survival to 25.1 months.
Area of Science:
- Ophthalmology
- Oncology
- Medical Imaging
Background:
- Cutaneous melanoma can metastasize to the orbit, posing unique diagnostic and therapeutic challenges.
- Orbital metastases from melanoma are rare but can significantly impact vision and quality of life.
Purpose of the Study:
- To detail the clinical characteristics, management strategies, and patient outcomes for 15 individuals with cutaneous melanoma metastatic to the orbit.
- To review current and emerging treatments for metastatic melanoma and their specific implications for ocular structures.
Main Methods:
- A retrospective chart review was conducted on 15 patients diagnosed with orbital metastasis originating from cutaneous melanoma.
- Data collected included clinical presentation, tumor characteristics, treatment modalities, and survival outcomes.
Main Results:
- Systemic metastasis was present in 87% of patients at the time of orbital metastasis diagnosis.
- Common signs included dysmotility (63%) and proptosis (56%); 75% of cases were painless.
- Orbital tumor control was achieved in 80% of cases with systemic chemotherapy and/or immunotherapy, with an overall survival of 25.1 months.
Conclusions:
- Cutaneous melanoma metastatic to the orbit typically manifests as a circumscribed, painless mass, frequently involving extraocular muscles.
- Systemic treatment approaches, including chemotherapy and immunotherapy, demonstrate significant efficacy in controlling orbital tumors.
- Combination therapy may offer improved survival outcomes compared to focal therapy alone.
