Integrating Surgery and Immunotherapy in the Treatment of Childhood Orbital Melanoma: A Case Report and the Literature Review

Ocular melanoma is a rare and quite deadly mutation in the eye located in the uvea or the conjunctiva, and its overall 5-year survival prognosis is around a dismal 24 months from the time of diagnosis. This report concerns a 12-year-old male presenting with secondary orbital melanoma of a previously excised conjunctival nevus. The progression of the tumor and treatment approaches are discussed, particularly in regard to the use of immunotherapy with checkpoint inhibitors such as Nivolumab. His first workup indicated a primary malignant melanoma and cervical lymph node metastasis that was suspicious and needed to be addressed via excisional biopsy and follow-up scans. While Nivolumab treated his initial symptoms of care quite effectively, subsequent treatment breaks led to complications, which necessitated a change to a mixed chemotherapy approach. Once Nivolumab was reinstituted, the patient improved significantly, which reinforces the idea that proactive management through surveillance and immunotherapy in combination can control ocular melanoma effectively.