Purpose of reviewThe management of cancer metastatic to the orbit and ocular adnexa (eyelid and periocular structures) has changed in recent decades. The purpose of this article is to review the incidence, presentation, and clinical features of metastatic tumors of the orbit and ocular adnexa and di

Metastatic tumors of the orbit and ocular adnexa.

Proton therapy – A systematic review of clinical effectiveness

In 2002 reporting of melanoma to cancer registries in Australia and New Zealand revealed it to be the fourth most common cancer and ninth most common cancer causing death in Australia and New Zealand. These registries reported melanoma incidence rates in males and females that were substantially above those from all other reporting registries worldwide1 • Increasing mortality from melanoma in Australian and New Zealand men is a disturbing trend • Exposure to ultraviolet (UV) radiation in sunlight is the primary cause of most melanoma • Intermittent pattern of sun exposure is most frequently associated with melanoma • Sun bed and tanning bed exposure is associated with a small increase in melanoma risk and may be more significant when exposure occurs before 35 years of age • Brief periods of sun exposure are needed to maintain vitamin D levels • In the absence of any substantial evidence as to its effectiveness in reducing mortality population-based screening cannot be recommended • It is important for practicing clinicians to be aware of high-risk groups in the population and that those in such groups also be aware of their status and establish a surveillance program • Early detection and diagnosis of melanoma is clearly important in sound management • Doubt in diagnosis or where melanoma is highly suspected, referral to a specialist or biopsy is appropriate. A 2mm margin for the biopsy is adequate. Prophylactic excision of benign naevi is not recommended • Diagnosis may be enhanced by clinicians trained in dermoscopy • It is imperative that all biopsy material be submitted for histopathological examination • Management of involved lymph nodes should be undertaken in specialist centres • Following diagnosis of metastatic melanoma, no further investigations are required unless surgery is planned and the detection of additional sites of distant disease would result in a change in management • Communication skills training should help promote patient-centred care, shared decision-making, empathy and support where desired • Timing of referral for palliative care relates to the needs of the patient and family, not just the stage of the disease • In treating specific populations, it is important to recognise cultural differences, particularly the final disposal of body parts after surgical removal in Maori and Pacific peoples. It is also good practice in physical examination to ensure that skin areas examined include periungual and subungual skin and soles of feet • Patients with high risk primary melanoma, lymph node involvement and melanoma in unusual sites (eg. mucosal and disseminated melanoma) are best managed by multidisciplinary teams in a specialist or melanoma facility • These evidence-based guidelines have been developed by a multidisciplinary volunteer working party. They are aimed at encouraging improved management through evidence-based decision-making • Guidelines are guides not rules and they are not prescriptive in any way. A good approach is to be fully aware of appropriate guidelines before making final management decisions. © Cancer Council Australia/Australian Cancer Network/Ministry of Health, New Zealand (2008).

Clinical practice guidelines for the management of melanoma in Australia and New Zealand

Radiation therapy for orbital tumors: concepts, current use, and ophthalmic radiation side effects.

Purpose To describe the clinical features, management, and outcomes of 15 patients with cutaneous melanoma metastatic to the orbit. The authors review emerging treatments for metastatic melanoma and their ocular implications. Methods Retrospective chart review of 15 patients with orbital metastasis from cutaneous melanoma. Results At presentation of the orbital metastasis, systemic metastatic cutaneous melanoma was present in 13 (87%) patients. The mean interval from diagnosis of cutaneous melanoma to orbital metastasis was 40 months (median, 37 months; range, 0-117 months). The most common presenting signs were dysmotility (63%), proptosis (56%), and blepharoptosis (19%). Four patients (25%) presented with pain. Metastasis involved extraocular muscle in 6 orbits (35%), intraconal space in 4 (24%), extraconal space in 7 (41%), and lacrimal sac in 1 (6%). The tumor was unifocal in all cases, unilateral in 13 patients (87%), and bilateral in 2 (13%). The mean tumor basal dimension was 20 × 20 mm and mean thickness was 16 mm. Treatments included complete surgical excision in 1 patient (6%), external beam radiotherapy (EBRT) in 7 (47%), systemic chemotherapy in 8 (53%), and immunotherapy in 5 (33%). Orbital tumor control was achieved in 2 orbits (18%) following focal therapy alone (excision or EBRT), 4 (36%) following systemic therapy alone (chemotherapy or immunotherapy), and 3 (27%) following combination focal plus systemic therapy. Three patients required exenteration. Survival rates at 1 year/2 years were 100%/0% following focal therapy, 50%/25% following systemic therapy, and 100%/66% following combination therapy. Conclusions Cutaneous melanoma metastatic to the orbit tends to involve muscle (35%) or intraconal soft tissue (24%) as a painless (75%), circumscribed (87%) mass. Treatment with systemic chemotherapy and/or immunotherapy resulted in orbital tumor control in 80% of cases. Overall survival was 25.1 months.

Cutaneous melanoma metastatic to the orbit: review of 15 cases.

Metastatic melanoma in the eye and orbit.

Rhabdomyosarcoma (RMS) is the most common primary malignant tumor of the orbit in childhood. The average age of onset is around seven years. In the present paper, the authors present the clinical and radiological findings in two newborns with histopathologically confirmed orbital rhabdomyosarcoma. A review of the literature was also carried out. In both children, the first sign leading to a visit was a unilateral proptosis, without symptoms or any other sign. Both underwent a CT-scan and an MRI. Confirmation of the histology was made by an open sky biopsy. The children were first treated by chemotherapy but had incomplete resolution of the tumor after more than 11 months for the first case and 9 months for the second. Since the parents of both children refused exenteration, radiotherapy had to be resorted to because of the incomplete response to chemotherapy. Our therapeutic approach and the outcome of these two cases are discussed.

Orbital rhabdomyosarcoma: Clinicopathologic correlation, management and follow-up in two newborns. A preliminary report.

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Metastatic melanoma in the eye and orbit.

Orbital rhabdomyosarcoma: Clinicopathologic correlation, management and follow-up in two newborns. A preliminary report.