Metastatic melanoma of the lacrimal sac.

The case history of a patient with metastatic melanoma obstructing the lacrimal sac is presented. To our knowledge, this case represents a unique metastatic pattern that has not been previously reported. The patient was first treated for a melanoma of the left arm, which was excised in continuity with the axillary lymph glands. She was free of disease for 3 years until she developed metastatic disease causing obstruction of the ipsilateral lacrimal sac. Anatomical details of the metastasis were provided by computed axial tomography. Treatment consisted of excision of the metastatic lesion with reconstruction using forehead and intranasal mucosal flaps, followed by irradiation, hyperthermia, and multiple-drug chemotherapy. Emphasis is placed here on the differential diagnosis of orbital adnexal tumors.