Melanoma Masquerade: A Case of Melanoma Masquerading as Orbital Lymphangioma

Secondary orbital melanoma is more common than primary orbital melanoma, and early detection is essential given the significant mortality associated with late-stage disease.This is especially challenging in patients with a retained phthisical eye, where limited direct visualization of the globe can result in delayed diagnosis and treatment.There are currently no formal guidelines for prophylactic enucleation of a blind eye; most enucleations in this setting are for patient comfort and cosmesis rather than malignancy prevention.A 68-year-old male with a 12-year history of a retained, non-painful phthisical eye presented to the emergency department with a progressively enlarging orbital mass for one year.The etiology of his earlier vision loss in the phthisical eye was unclear.Contrast-enhanced CT and MRI studies showed a large, heterogeneous enhancing left orbital mass with fluid levels, osseous remodeling, and absence of an intact left globe, which favored a lymphangioma diagnosis.He underwent superior orbitotomy for biopsy, and the mass grossly resembled a lymphangioma with cystic cavities containing coagulated blood.Pathology was consistent with melanoma.Orbital exenteration was recommended; a PET scan revealed stage IV disease with hepatic and osseous metastases.The patient elected against exenteration given his poor prognosis, and he is currently undergoing palliative chemotherapy.