Purpose

Melanoma in the orbit is uncommon as a metastatic lesion and rare as a primary tumor. We present two cases of patients with melanoma involving the orbit who responded to treatment with immunotherapy.

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Methods

Retrospective review of medical records.

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Results

The first patient is a 38-year-old female with a history of T1bN0M0 cutaneous melanoma presenting with numerous metastatic subcutaneous nodules and a single metastasis to the left orbit 9 years after excision of the original lesion. She was treated with a CTLA-4 inhibitor, ipilimumab, and a PD-1 inhibitor, nivolumab, which were stopped after 2 cycles due to severe hepatitis, determined to be secondary to dietary supplements. Due to disease progression, she was then treated with 30 Gy radiation therapy in 10 fractions followed by a combination of nivolumab and LAG-3 inhibitor, relatlimab, for two years, with no significant adverse reactions. The patient achieved a complete response to treatment with no evidence of disease 30 months after treatment initiation. The second case is a 77-year-old female with a history of a left orbital lesion, surgically debulked and diagnosed as a nerve sheath tumor. Due to progressive growth one year later, she underwent two additional surgeries, with a diagnosis change to a spindled cell melanoma with perineural invasion involving the left anterior orbit, lacrimal sac, medial canthus, and upper eyelid. Staging at presentation found no metastatic disease. She was treated with a combination of ipilimumab and nivolumab for 4 cycles and an additional nivolumab cycle, with a complete response to treatment. The treatment was stopped due to multiple toxicities, including adrenal insufficiency, diarrhea, renal failure, and pneumonitis. She remains with no evidence of disease 18 months after treatment initiation and 15 months since treatment was stopped. Both patients maintained good vision in the involved eye at the last follow-up.

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Conclusion

Immunotherapy with or without radiation therapy achieved a complete response in the treatment of metastatic cutaneous melanoma to the orbit and a primary spindled-cell melanoma of the orbit.

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Additional Authors

First name	Last name	Base Hospital / Institution
Devarati	Mitra	The University of Texas MD Anderson Cancer Center
Amina	Chaudhry	The University of Texas MD Anderson Cancer Center
Hussein	Tawbi	The University of Texas MD Anderson Cancer Center
Isabella	Glitza	The University of Texas MD Anderson Cancer Center

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