# Periocular Desmoplastic Malignant Melanoma and Orbital Invasion With Uncontrollable Disease: A Case Report

## TL;DR

A 78-year-old man with aggressive periocular melanoma underwent surgery but eventually died from metastasis despite initial disease-free survival.

## Contribution

This case report highlights the challenges in treating and reconstructing periocular desmoplastic melanoma with orbital invasion.

## Key findings

- The patient remained disease-free for 1.5 years after surgery but later experienced recurrence and metastasis.
- Extended orbital exenteration and reconstruction with a temporalis muscle flap were used to manage the tumor.
- The case illustrates the poor long-term prognosis of aggressive periocular melanoma despite aggressive treatment.

## Abstract

Primary orbital melanoma and metastatic cutaneous melanoma of the orbit are extremely rare. Desmoplastic melanoma (DM) is an infrequent variant of melanoma that can extend from a superficial location into deep tissues by neurotropic mechanisms.

A 78-year-old male was referred to us with a periocular mixed malignant melanoma (spindle cell melanoma with desmoplastic reaction) in his left lower eyelid with uncontrollable disease (orbital and inferior orbital rim invasion) despite treatment. The surgical technique consisted of an extended orbital exenteration, maxillectomy, and ethmoidectomy, with a 2 cm macroscopic surgical margin. We performed a delayed socket reconstruction with a temporalis muscle flap using a transorbital approach.

The patient remained disease-free for 1.5 years with a good quality of life since exenteration surgery. At this time, he presented a recurrence in the area of the malar scar with a new orbital invasion, and finally, he died due to mediastinal, pleural, and pulmonary metastasis.

The treatment of a cutaneous melanoma arising in the periocular region is a challenging reconstructive problem and it may compromise the globe and visual function.