Primary orbital melanoma treated with orbital exenteration and postoperative radiotherapy: A case report and review of the literature.

Abstract

We report on a patient with human immunodeficiency virus (HIV)-positive disease with a primary orbital melanoma treated with surgery and adjuvant radiation. A 53-year-old woman with HIV-positive disease presented with left-sided progressive ipsilateral vision loss and proptosis. An MRI scan revealed a mass-enhancing lesion measuring 2.1 × 2.6 × 2.5 cm abutting the optic nerve. The patient underwent left orbital exenteration with temporalis flap reconstruction, pathology revealing malignant melanoma, stage T1N0M0. Posterior margins were positive and lymphovascular invasion was present; therefore, the patient received adjuvant radiation to a total dose of 70 Gy in 35 fractions. The patient remains with no evidence of disease (NED) at a follow-up time of 3.5 years. Surgery remains the mainstay of treatment in patients with primary orbital melanomas, and adjuvant radiotherapy should be considered for those with positive margins or other risk factors for recurrence. We present a patient with significant risk factors with NED at 3.5-year follow-up.