Intraconal extra-ocular malignant melanoma metastasis

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient with known metastases to the lungs from malignant (cutaneous) melanoma presented with a short history of left-sided proptosis, chemosis and ecchymosis. Orbital apex syndrome was suspected.

Patient Data

Age: 65
Gender: Male

Contrast-enhanced CT orbits

CT

On the left, there is a 2.5cm x 2.5cm x 2.5cm intraconal mass situated bewteen the optic nerve and lateral rectus. The mass is separate to, but displaces the optic nerve. There is no fat plane between the mass and the lateral rectus, but the belly of lateral recuts is of normal caliber. There is mild proptosis. The lateral orbital wall is normal. The orbital apex is not affected.

Case Discussion

Metastatic melanoma to the eyes and orbits is rare 1.  Breast cancer is the most common primary cancer to cause metastases to the orbits 2. Breast cancer metastases are often irregular lesions 3, in contradistinction to the mass seen in this case.

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