Conjunctival melanoma 3 years after radiation and chemotherapy for retinoblastoma

Conjunctival Blue Naevus in an Anophthalmic Socket

PURPOSE OF THE STUDY

To describe an unusual brown pigmented lesion of the conjunctiva in an anophthalmic socket in a 16-year-old male.

PROCEDURES

A 16-year-old male patient presented with socket irritation whilst wearing an artificial eye due to meibomian gland dysfunction. An area of flat, subepithelial, dark brown pigmentation with irregular and indistinct borders on the bulbar conjunctiva of the anophthalmic socket was seen. The patient believed it had been present for at least 2 years. His past ocular history was of childhood trauma to the right eye at the age of 9 years, and he underwent primary enucleation and hydroxyapatite orbital implant insertion at that time. Unfortunately, the implant extruded and was removed a year later.

RESULTS

An incisional biopsy of the pigmented lesion showed a conjunctival, subepithelial bland spindle cell melanocytic lesion, with uniform-sized and -shaped melanosomes. Immunohistochemistry showed the cells to express Melan A and HMB45 and they were negative for CD68 and pan-cytokeratins. The features were of a common blue naevus.

CONCLUSION

This is the first documentation of a post-enucleation conjunctival naevus in an anophthalmic socket. We propose a pathogenesis and suggest surveillance as there is a risk of transformation to melanoma.

Development of Malignant Melanoma of the Orbit in Previous Radiation Field

We present a case of a 40-year-old woman with a history of retinoblastoma in the left eye treated with enucleation and radiation therapy as an infant who recently developed worsening pain and exophthalmos in her right eye. Multimodality imaging demonstrated an enhancing, FDG-avid mass in the medial right orbit with associated bone destruction and extension into the ethmoid sinus. Pathologic analysis after excision showed a highly undifferentiated tumor consistent with melanoma. Although development of malignant melanoma in an irradiated field is rare, it should be considered in the differential, especially in childhood cancer survivors at increased risk of second malignant neoplasms.

Metastasis to optic nerve presenting as ill-fitting prosthesis

We report a rare case of metastatic adenocarcinoma of lung in anophthalmic socket, which presented as painful and difficult prosthetic wear long after an uneventful enucleation. Bulge in the socket indicated amputation neuroma, a rarity in itself; but further evaluation concealed a yet silent pulmonary mass. No case report so far describes metastatic mass in an anophthalmic socket and we describe first case of unknown lung malignancy presenting as ill-fitting prosthesis.