Lifting the Lid on Best Practice in a Case of Oligometastatic Breast Cancer

Ophthalmic metastases are uncommon, and rarely seen in the eyelid. Existing literature to inform post-operative management is limited.

We present the case of a 63-year-old woman, diagnosed with oligometastatic breast carcinoma after presenting to her general practitioner (GP) with a recurrent right upper eyelid lesion postsurgical excision. Eight years previously, she had received surgery followed by adjuvant chemotherapy, radiotherapy and endocrine therapy for a left grade 2, oestrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer.

We discuss the case literature on the management of ophthalmic and eyelid metastases, including the role of radiotherapy. We outline the multi-disciplinary team (MDT) discussions and recommendations made in the present case, which ultimately found that the risks of radiation toxicity would outweigh the benefits. Adjuvant therapy with fulvestrant and palbociclib was recommended, with future consideration of a CDK 4/6 inhibitor in the event of metastatic recurrence.