A case is presented of a 58-year-old retarded male with a 6 cm, painless, hard, pigmented tumor filling the left orbit completely, after enucleation 21 years previously for retinal detachment, glaucoma and no light perception. CT scan and MRI revealed, besides the tumor, an outspoken enlargement of the bony orbit with thinning of the orbital walls. A biopsy showed a spindle B cell melanoma. In one of the paraffin histology sections of the globe enucleated 21 years previously a very small spindle B cell melanoma under the detached retina was present, with tumor cells in several vortex veins. The tumor was debulked centrally and it was exenterated and the eyelid skin was closed over the empty orbit. The patient is well 15 months after surgery. This case re-emphasizes that a choroidal melanoma can recur locally decennia after enucleation, that the histology of the tumor may change concomitantly and that a slowly growing orbital tumor can enlarge the bony orbit without perforating the periborbit or eroding the bone.

choroidal melanoma, exenteration, orbital anatomy, orbital tumor
dx.doi.org/10.3109/01676839209087672, hdl.handle.net/1765/40365
Orbit
Department of Ophthalmology

Simonsz, H.J, & Löffler, K. (1992). Enlargement of the bony orbit by orbital recurrence of choroidal melanoma 21 years after enucleation . Orbit, 11(1), 7–10. doi:10.3109/01676839209087672