Malignant Melanoma of the Lacrimal Sac: Case Report and Major Review with Treatment Update

Purpose: To present a rare case of Primary Lacrimal Sac Melanoma, and review all reports of this condition in the literature to date. Methods: In this review the clinical characteristics, presenting symptoms, treatment and morbidity of all patients with lacrimal sac melanoma reported in the literature from 1926 to the present. We have also discussed new approaches available for adjuvant radiotherapy in the context of this frequently recurrent tumour. Results: Primary Melanoma of the Lacrimal Sac is a rare disease which is frequently diagnosed late. Common presenting symptoms include epiphora, blood-stained tears and painless swelling. Intensity modulated radiation therapy appears to hold promise in the adjuvant treatment of this disease, to reduce morbidity and mortality from recurrence and/ or metastasis. Conclusions: Existing case series and reports of Lacrimal Sac Melanoma describe a variety of treatment regimens and poor follow-up highlighting the lack of a widely accepted strategy to prevent recurrence of disease. This case and review reminds practitioners of presenting signs and symptoms that should raise suspicion of Lacrimal Sac Melanoma, and a contemporary approach to adjuvant radiation therapy.