Clinical study of 37 cases of orbital melanoma

Abstract

Background: To analyze the clinical features and prognosis of orbital melanoma.

Design: Retrospective observational case series.

Methods: A retrospective analysis of the electronic medical records, histopathology, imaging examinations, and follow-up information of 37 patients with orbital melanoma.

Results: The most common primary site was the conjunctiva, with half of the patients presenting with orbital involvement at the initial visit. The most common symptoms were globe displacement due to intraorbital mass, causing swelling of the eyelids and blurred vision. All patients underwent mass excision surgery. Rates of intraorbital soft tissue infiltration, nerve invasion, and bone destruction were 48.6%, 18.9%, and 13.5%, respectively. Five patients (13.5%) have distant metastases to the liver, bones, lungs, skin, and parotid lymph nodes. The Median Survival Time of the 13 deceased patients was 132 ± 24.88 months, with a 5-year survival rate of 78.4%±7.3%. The presence of nerve invasion showed a significant correlation with prognosis (P = 0.047 < 0.05), while age, gender, eye involvement, bone destruction, and intraorbital soft tissue infiltration showed no significant correlation with prognosis (P > 0.05). The expression of Ki-67 was negatively correlated with patient survival time and rate, where higher Ki-67 expression was associated with shorter survival time (r²=-0.267, r²=-0.067).

Conclusions: Treatment strategies for orbital melanoma should consider the tumor's invasive characteristics and Ki-67 expression levels to optimize treatment outcomes and improve patient survival rates. Furthermore, due to the significant impact of nerve involvement on prognosis, it is recommended that clinical focus on this factor be enhanced.

Keywords: Clinical presentation; Melanoma; Orbit; Prognosis; Treatment.

Fig. 1

A-C: Imaging changes of orbital melanoma (A) Horizontal T1WI enhanced scan image. (B) Horizontal T2WI scan image. (C) The enhancement scan shows uneven enhancement

Fig. 2

A-D: Histopathological changes of orbital melanoma (Primary tumor location: choroid) (A) He-100X, (B) He-400x, (C) He-200X Nerve invasion, (D) He-40X Lamina cribrosa invasion. G-I: Immunohistochemical Staining of Orbital Melanoma. (E) HBM45(+) (F) Meland-A (+), (G) S-100 (+), (H) Ki-67 (+), (I) Vimentin (+), (J) CyclinD1 (+)

Fig. 3

A. Kaplan-Meier survival analysis of 37 patients. The 5-year survival rate was 78.4%±7.3%. B. Kaplan-Meier Survival Analysis of 37 Patients (According to ki-67 Expression). C. Kaplan-Meier Survival Analysis of 37 Patients (According to Primary Tumor Origin). D. The time interval between the diagnosis of primary melanoma and the appearance of orbital disease in 37 patients