Longitudinal Volumetric Trajectory, Trans-Midline Sinonasal Osteolysis, and Stage IV Progression Following Inadvertent Evisceration and Delayed Adjuvant Chemotherapy in Recurrent Orbital Malignant Melanoma: An Observational Analytic Case Study

Abstract

Background: Orbital malignant melanoma is an aggressive craniofacial malignancy. Scleral disruption at evisceration and delayed systemic therapy may precede local relapse and metastasis.

Objective: To describe the volumetric course and staging evolution of a neglected recurrent orbital melanoma.

Methods: A 56-year-old female farmer was followed for 31.5 months (August 2023 to March 2026) at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Indonesia, across eight epochs (T₀ to T₇). Tumor volume was calculated by ellipsoid volumetry (V = [π/6] × L × W × H) and described by percentage change (Δ%), specific growth rate (SGR), and doubling time (Td). No inferential statistics were applied.

Result: After inadvertent right ocular evisceration for presumed bulbar prolapse (T₀) and semi-enucleation confirming melanoma (T₁), a 6-month referral delay was followed by a 4.80 × 4.60 × 4.20 cm (48.56 cm³) Stage IIIC (cT4eN0M0) orbital mass invading the optic nerve and extraocular muscles (T₂). Radical orbital exenteration (T₃) showed epithelioid melanoma with tumor-positive (R1/R2) bony margins. The patient repeatedly refused adjuvant dacarbazine. A 2.95 cm³ socket relapse appeared at T₅. Over 210 untreated days the volume rose 44.42-fold (Δ% = +4,341.69%; SGR = 1.81%/day; Td = 38.37 days) to a 6.50 × 7.00 × 5.50 cm (131.03 cm³) mass with bilateral sinonasal destruction, inferoauricular lymphadenopathy, and suspected pulmonary metastasis (Stage IV, cT4eN1M1; T₆).

Conclusion: In this patient, inadvertent evisceration and non-adherence to chemotherapy for socioeconomic reasons were followed by rapid osteolytic recurrence and Stage IV dissemination. One case cannot show causation.