CASE REPORTS RAPPORTS DE CAS

Primary orbital melanoma without ocular

involvement in a Balinese cat
Louis-Philippe de Lorimier

Abstract — A 6.5-year-old spayed female Balinese cat was diagnosed with a large and locally
invasive primary orbital melanoma, without ocular involvement or detectable metastatic disease.
Advanced imaging and immunohistochemical studies helped in obtaining the diagnosis. Because of
advanced unresectable disease and ensuing poor quality of life, the cat was euthanized.

Résumé — Mélanome orbital primaire chez un chat balinais. Un diagnostic de mélanome orbital
primaire, important et localement invasif, sans atteinte oculaire ou métastases détectables a été posé
sur une chatte balinaise stérilisée âgée de 6.5 ans. L’imagerie de pointe et les études immunohisto-
chimiques ont contribué à l’obtention du diagnostic. Vu le stade avancé de la maladie, l’impossibilité
d’une résection et la dégradation de la qualité de vie qui suivrait une intervention, la chatte a été
euthanasiée.
(Traduit par Docteur André Blouin)
Can Vet J 2006;47:225–228

A 6.5-year-old, spayed female, cream tabby Balinese

cat was presented to the University of Illinois
Veterinary Teaching Hospital (UIVTH) for evaluation of
a large periorbital swelling on the left side, and ongoing
weight loss. For 6 wk prior to referral, the cat had been
treated for a presumptive abscess. On 3 different occa-
sions, incisions on the soft palate and on the outer peri-
orbital swelling were performed. A 4th premolar tooth
had also been extracted. Three courses of oral antibiotics
had been administered (amoxicillin, clindamycin, and
amoxicillin-clavulanic acid), but they did not result in
significant clinical improvement. On the 3rd visit, the
cat had a febrile episode (40°C). Plain radiographs of the
head did not show evidence of a radiopaque foreign
object, or obvious osteolysis. The results of a complete
blood (cell) count (CBC) were within reference ranges.
The patient was then referred to the UIVTH medical
oncology service for further evaluation. Figure 1. Large soft-tissue mass around the left eye of an adult
female Balinese cat. The skin incision had been made prior to
presentation in an attempt to lance a suspected abscess.
Case description
On presentation to the UIVTH, the patient was thin discharge. A small ulcerated area was observed in the
(2.68 kg), mildly clinically dehydrated, and had normal mouth, at the site of previous 4th premolar excision. At
vital signs. A large and firm periorbital swelling was that time, the main differential diagnoses were abscess,
observed on the left side (Figure 1). The left eye could neoplasia (orbital lymphoma, squamous cell carcinoma,
not be visualized, and a serosanguineous discharge was soft tissue sarcoma, uveal melanoma with orbital exten-
observed at the palpebral fissure. The cat demonstrated sion), and pseudotumor (granulomatous disease, bacterial
signs of pain upon opening the mouth, had increased cellulitis, inflammatory infiltrate).
upper respiratory noises (stertor), and a serous left nasal A CBC, serum biochemical profile, and urinalysis
(U/A) were performed. The results from the CBC and
Department of Veterinary Clinical Medicine, Veterinary U/A did not reveal any abnormality, and the only abnor-
Teaching Hospital, University of Illinois, 1008 West Hazelwood mal value on the biochemical panel was a mildly elevated
Drive, Urbana, Illinois 61802-4714, USA. globulin level (56 g/L; reference range 26 to 51 g/L).
Address all correspondence and reprint requests to Three-view thoracic radiographs were obtained (ventro-
Dr. Louis-Philippe de Lorimier; e-mail: delorimi@uiuc.edu dorsal and left and right laterals) and interpreted as being

Can Vet J Volume 47, March 2006 225

Figure 2. Spindle-shaped cells with anisokaryosis, anisocyto-
sis, large prominent nucleoli (arrowheads), and scattered dark
cytoplasmic granules (Wright-Giemsa stain). The very dark
cell with cytoplasmic vacuoles (thin arrow) is a melanophage.
Bar = 20 µm.
normal. An abdominal ultrasonographic study failed to
reveal any significant finding. The periorbital swelling
was also evaluated with ultrasound under sedation. A
fine-needle aspiration of the soft tissue swelling was
performed, and slides were submitted for cytopathologi-
cal analysis, which revealed very large, solitary or clus-
tered, spindle-shaped cells containing large round to oval
nuclei, many with a large prominent central nucleolus
(Figure 2). The cytoplasm was light basophilic, with
elongated outlines and black cytoplasmic granules scat-
tered throughout. These cytopathological findings were
suggestive of a melanoma.
The owners were notified of the presumptive diagno-
sis of orbital melanoma, either primary or secondary to
orbital extension from a uveal melanoma, and a poor
prognosis was given, owing to the very invasive nature
and advanced stage of the neoplasm, and to a markedly
decreased quality of life. They nevertheless elected that
the cat should have a computerized tomography (CT)
scan, in order to further determine local invasion and
better assess the potential for surgical resection. The cat
was hospitalized and monitored in the intensive care unit
overnight, with continuous maintenance IV fluids (lac-
tated Ringer’s) and oxymorphone (Numorphan; Schering
Plough Animal Health, Union, New Jersey, USA) injec-
tions, 0.07 mg/kg bodyweight (BW) IV, q5h. The CT scan
was performed the following morning, when a very large
orbital contrast-enhancing mass was identified compress-
ing the left eye and invading into the nasal cavity and
nasopharynx (Figure 3). Since the prognosis was very
poor, the invasive mass was considered unresectable, and
knowing that the quality of life could not be substantially
improved, the owners opted for euthanasia. A complete
necropsy was declined, but postmortem enucleation and
orbital tissue biopsies were allowed.
Complete histopathologic examination of the left eye
showed multiple severe changes, including subacute lens
rupture, with anterior and posterior segmental hemor-
Figure 3. Computerized tomography (CT) imaging of a
Balinese cat with a large periorbital irregularly contrast-
enhancing mass (asterisks), compressing and distorting the
left eye, and invading into the left nasal cavity (arrowheads 1)
and nasopharynx (arrowhead 2). The round structures in the
mouth are the tracheal tube (large) and esophageal stethoscope
(small).
rhage and fibrosis; posterior synechiae; retinal detach-
ment, with outer retinal necrosis and hemorrhage; and
subacute central corneal ulceration. These changes were
interpreted as traumatic and degenerative in nature, and
nonneoplastic. The biopsies of orbital tissue and the third
eyelid revealed atypical cells with a modest amount of
cytoplasm that appeared highly vacuolated and had
poorly defined borders. The nuclei were highly pleomor-
phic, anisokaryotic, round, and often indented. They had
open vesicular chromatin with multiple, variably sized
and shaped, large nucleoli. Mitotic figures were common
(3 to 4/400 field) and atypical. Individual cell necrosis
was also common. This was interpreted as a poorly dif-
ferentiated sarcoma.
Given the results of cytopathologic and histopathologic
characteristics, the periorbital mass was suggestive of an
amelanotic melanoma, but because of the poor differen-
tiation, other sarcomas, anaplastic round cell tumors
(including lymphoma), and a carcinoma of the third
eyelid gland could not be definitively ruled out. Special
and immunohistochemical staining was requested to
provide a more definitive diagnosis. No melanin granules
could be identified with a Warthin-Starry stain. Vimentin
immunostain was positive on most of the tumor cells,
confirming a mesenchymal cell origin, whereas cyto-
keratin staining was negative, ruling out an epithelial
tumor. Faint cytoplasmic staining was observed in many
tumor cells with Melan A immunostain, suggesting a
melanocytic origin. The final diagnosis was a poorly
differentiated amelanotic melanoma of the orbital tissues,
without primary ocular involvement.
Discussion
Orbital and retrobulbar tumors are occasionally observed
in cats and dogs, and a variety of histologic types have
been described (1–12). They can be characterized as
primary, when arising from any tissues that compose and
Can Vet J Volume 47, March 2006
surround the orbit, or secondary when resulting from
orbital extension of tumors of the globe or optic nerve,
the nasal cavity or paranasal sinuses, the salivary glands,
or orbital involvement by systemic neoplasia (1–12).
The most frequently described orbital tumor in cats is
squamous cell carcinoma, followed by other carcinomas,
lymphoma, melanoma, and various sarcomas (6–8,10).
Other sporadically reported types of feline orbital tumors
include hemangioma, chondroma, meningioma, plasma-
cytoma, and osteoma (6,8,9,11,12). A vast majority of
cats reported as having orbital tumors, in fact, have sec-
ondary orbital extension by primary ocular melanomas,
primary sinonasal, oral, or cunjunctival carcinomas, or
orbital involvement by systemic or nasal lymphomas
(6–8).
In dogs, the most commonly reported orbital tumors
are osteosarcomas, various soft-tissue sarcomas and
carcinomas, mast cell tumors, meningiomas, lobular
adenomas, and multilobular tumors of bone (1–4,7,8).
Other types of canine orbital tumors include melanomas,
lymphomas, leiomyoma, osteoma, hemangiosarcoma,
and retinoblastoma (4,5,7,8). Similar to cats, many canine
orbital squamous cell carcinomas and adenocarcinomas
described in the literature are actually invasive primary
sinonasal tumors with secondary orbital extension
(1,4,7,8).
A thorough search of the veterinary literature in
English revealed reports on only 5 cats with melanoma
in the orbital area without primary ocular involvement
(13–15). All 5 cats had malignant melanomas, 4 involv-
ing the bulbar conjunctiva (13,15) and 1 originating in
the nictitating membrane (14). Four of these 5 cats devel-
oped diffuse metastatic disease (14,15). While a defini-
tive diagnosis was not reached, an additional cat was
reported to have a presumptive primary melanoma of the
upper palpebral cunjunctiva, with orbital infiltration and
regional metastases (16). In the case presented here, the
tumor was remarkably large and locally aggressive, fill-
ing the entire orbit, causing severe traumatic changes to
the globe, and invading the caudal nasal cavity and naso-
pharynx. There was no evidence of primary or secondary
ocular involvement, and clinical staging could not dem-
onstrate measurable metastatic disease. The exact origin
of the bulky orbital tumor could not be determined.
Malignant melanoma is well described in cats, the
most common primary sites being the eye and the dermis
(6,13–15,17–23). While many cases of feline oral mela-
noma have been reported, the mouth is a much more
common primary site of involvement in dogs (15,21–23).
Feline malignant melanoma appears to be an aggressive
tumor, both locally and with a high rate of dissemination,
independent on the primary site of origin (6,15,17–23).
While surgery remains the most effective form of therapy
(15,17–20,22), a recent report described hypofractionated
megavoltage radiation therapy for unresectable oral
melanomas in 5 cats (23). Occasionally, feline melanoma
cells may be less pigmented, with additional stains being
required to confirm the diagnosis (14,19,21). A recent
study on 48 cases concluded that Melan A, while being
somewhat less sensitive than S100, was a more specific
immunostain for poorly pigmented feline melanomas
(21). The use of Melan A was helpful to confirm the
histopathologic diagnosis of orbital melanoma in the case
Can Vet J Volume 47, March 2006
presented here. It is interesting to notice the discrepancy
between the cytopathologic examination, which easily
identified cytoplasmic melanin granules (Figure 2), and
the histopathologic examination, which required immu-
nostains to better define the cells observed. This differ-
ence may stem from a very heterogeneous tumor, with
some areas being better differentiated than others.
While abscesses and tumors are the cause of most
orbital mass effects, other conditions have been reported
and are occasionally encountered (24–33). Many of
these reports involve cats with conditions such as orbital
cellulitis with Penicillium sp. (24), orbital eosinophilic
infiltrate (25), orbital aspergillosis (26), inflammatory
retrobulbar pseudotumor (27), and nasal and retrobul-
bar infection with Pythium insidiosum (28). Reports
of canine cases include orbital cryptococcosis (29),
orbital cellulitis from Toxocara canis (30), sino-orbital
aspergillosis (31), orbital cellulitis from the nasal mite
Pneumonyssus caninum (32), orbital mucocele (33), and
solitary naso-orbital blastomycosis without systemic
involvement at presentation (34).
Biopsy and histopathologic examination remains the
only way to definitely diagnose a suspect orbital tumor,
but imaging of the orbit is also very useful to determine
if a mass is present and to better plan diagnostic or
therapeutic intervention. Sectional imaging is far superior
to radiography for that purpose (4,33–39). A report
describing the use of ultrasonographic studies in 50 dogs
with retrobulbar disease demonstrated that a mass effect
was identified in 42% of dogs with neoplasia and in 30%
of dogs with abscesses (33). Because ultrasonic signals
can only travel through fluid and soft-tissues, advanced
imaging modalities, such as CT or magnetic resonance
imaging (MRI), prove to be much superior for thorough
evaluation of the orbital cavity and surrounding bony
structures (34–39). In the case presented here, while
ultrasonographs showed evidence of a mass effect in the
orbit, imaging with contrast-enhanced CT clearly identi-
fied a large orbital mass with invasion into the nasal
cavity and nasopharynx, and allowed visualization of
bone destruction (Figure 3). Surgical resection was there-
after not considered a reasonable option for this cat.
Orbital tumors are best treated with surgical resection,
occasionally requiring orbital exenteration for large or
invasive tumors (2–4,6–8,10–13,40). With specific radio-
sensitive tumor types, such as lymphomas, plasmacyto-
mas, and some carcinomas, megavoltage radiation ther-
apy and cytotoxic chemotherapy, alone or in combination
depending on subtype and grade, can occasionally be
considered first-line therapy (4–6,8). When orbital
tumors invade the surrounding structures, surgical exci-
sion may need to be followed by radiation therapy, che-
motherapy, or both on microscopic disease for improved
long-term control (4,7,8,40). The prognosis of treated
orbital tumors varies markedly with the type of tumor,
the size and invasiveness, the type of therapy, and
between studies. Very good survival times and quality of
life can be expected with benign and completely excised
tumors, but a grave prognosis may accompany unresect-
able or widely disseminated tumors. The cat reported
here was euthanized after confirmation of the diagnosis
because of poor quality of life and locally very advanced,
incurable disease. CVJ
227
 References
1. Kern TJ. Orbital neoplasia in 23 dogs. J Am Vet Med Assoc
1985;186:489–491.
2. Mauldin EA, Deehr AJ, Hertzke D, Dubielzig RR. Canine orbital
meningiomas: a review of 22 cases. Vet Ophthalmol 2000;3:
11–16.
3. Headrick JF, Bentley E, Dubielzig RR. Canine lobular orbital
adenoma: a report of 15 cases with distinctive features. Vet
Ophthalmol 2004;7:47–51.
4. Hendrix DV, Gelatt KN. Diagnosis, treatment and outcome of
orbital neoplasia in dogs: a retrospective study of 44 cases. J Small
Anim Pract 2000;41:105–108.
5. Aquino SM, Hamor RE, Valli VE, et al. Progression of an orbital
T-cell rich B-cell lymphoma to a B-cell lymphoma in a dog. Vet
Pathol 2000;37:465–469.
6. Gilger BC, McLaughlin SA, Whitley RD, Wright JC. Orbital neo-
plasms in cats: 21 cases (1974–1990). J Am Vet Med Assoc 1992;
201:1083–1086.
7. O’Brien MG, Withrow SJ, Straw RC, Powers BE, Kirpensteijn JK.
Total and partial orbitectomy for the treatment of periorbital tumors
in 24 dogs and 6 cats: a retrospective study. Vet Surg 1996;25:
471–479.
8. Attali-Soussay K, Jegou JP, Clerc B. Retrobulbar tumors in dogs
and cats: 25 cases. Vet Ophthalmol 2001;4:19–27.
9. Ward DA, McEntee MF, Weddle DL. Orbital plasmacytoma in a
cat. J Small Anim Pract 1997;38:576–578.
10. Pentlarge VW, Powell-Johnson G, Martin CL, et al. Orbital neo-
plasia with enophthalmos in a cat. J Am Vet Med Assoc 1989;
195:1249–1251.
11. Knecht CD, Greene JA. Osteoma of the zygomatic arch in a cat.
J Am Vet Med Assoc 1977;171:1077–1078.
12. Cottrill NB, Carter JD, Pechman RD, Dubielzig RR, Waldron DR.
Bilateral orbital parosteal osteoma in a cat. J Am Anim Hosp Assoc
1987;23:405–408.
13. Cook CS, Rosenkrantz W, Peiffer RL, MacMillan A. Malignant
melanoma of the conjunctiva in a cat. J Am Vet Med Assoc
1985;186:505–506.
14. Roels S, Ducatelle R. Malignant melanoma of the nictitating
membrane in a cat (Felis vulgaris). J Comp Pathol 1998;119:
189–193.
15. Patnaik AK, Mooney S. Feline melanoma: a comparative study of
ocular, oral, and dermal neoplasms. Vet Pathol 1988;25:105–112.
16. Wolfer J, Grahn B. Diagnostic ophthalmology. Can Vet J 1995;
36:518–519.
17. Kalishman JB, Chappell R, Flood LA, Dubielzig RR. A matched
observational study of survival in cats with enucleation due to
diffuse iris melanoma. Vet Ophthalmol 1998;1:25–29.
18. Harris BP, Dubielzig RR. Atypical primary ocular melanoma in
cats. Vet Ophthalmol 1999;2:121–124.
19. van der Linde-Sipman JS, de Wit MM, van Garderen E, Molenbeek
RF, van der Velde-Zimmermann D, de Weger RA. Cutaneous
malignant melanomas in 57 cats: identification of (amelanotic)
signet-ring and balloon cell types and verification of their origin
by immunohistochemistry, electron microscopy, and in situ hybrid-
ization. Vet Pathol 1997;34:31–38.
20. Day MJ, Lucke VM. Melanocytic neoplasia in the cat. J Small Anim
Pract 1995;36:207–213.
21. Ramos-Vara JA, Miller MA, Johnson GC, Turnquist SE, Kreeger
JM, Watson GL. Melan A and S100 protein immunohistochemistry
in feline melanomas: 48 cases. Vet Pathol 2002;39:127–132.
22. Luna LD, Higginbotham ML, Henry CJ, Turnquist SE, Moore AS,
Graham JC. Feline non-ocular melanoma: a retrospective study of
23 cases (1991–1999). J Feline Med Surg 2000;2:173–181.
23. Farrelly J, Denman DL, Hohenhaus AE, Patnaik AK, Bergman PJ.
Hypofractionated radiation therapy of oral melanoma in five cats.
Vet Radiol Ultrasound 2004;45:91–93.
24. Peiffer RL, Belkin PV, Janke BH. Orbital cellulitis, sinusitis, and
pneumonitis caused by penicillium sp in a cat. J Am Vet Med Assoc
1980;176:449–451.
25. Dziezyc J, Barton CL, Santos A. Exophthalmia in a cat caused
by an eosinophilic infiltrate. Prog Vet Comp Ophthalmol 1992;
2:91–93.
26. Hamilton HL, Whitley RD, McLaughlin SA. Exophthalmos second-
ary to aspergillosis in a cat. J Am Anim Hosp Assoc 2000;36:
343–347.
27. Miller SA, van der Woerdt A, Bartick TE. Retrobulbar pseudotumor
of the orbit in a cat. J Am Vet Med Assoc 2000;216:356–358.
28. Bissonnette KW, Sharp NJ, Dykstra MH, et al. Nasal and retrobul-
bar mass in a cat caused by Pythium insidiosum. J Med Vet Mycol
1991;29:39–44.
29. Rebhun WC, Edwards NJ. Cryptococcosis involving the orbit of a
dog. Vet Med Small Anim Clin 1977;72:1447–1450.
30. Laus JL, Canola JC, Mamede FV, et al. Orbital cellulitis associated
with Toxocara canis in a dog. Vet Ophthalmol 2003;6:333–336.
31. Willis AM, Martin CL, Stiles J. Sino-orbital aspergillosis in a dog.
J Am Vet Med Assoc 1999;214:1644–1647.
32. Roberts SR, Thompson TJ. Pneumonyssus caninum and orbital
cellulitis in the dog. J Am Vet Med Assoc 1969;155:731–734.
33. Mason DR, Lamb CR, McLellan GJ. Ultrasonographic findings in
50 dogs with retrobulbar disease. J Am Anim Hosp Assoc
2001;37:557–562.
34. de Lorimier LP, Lacoste HI, Linnetz EH, Huskey AM.
Blastomycosis: Buddy’s budding problem. Vet Forum 2005;22:
29–38.
35. LeCouteur RA, Fike JR, Scagliotti RH, Cann CE. Computed
tomography of orbital tumors in the dog. J Am Vet Med Assoc
1982;180:910–913.
36. Daniel GB, Mitchell SK. The eye and orbit. Clin Tech Small Anim
Pract 1999;14:160–169.
37. Dennis R. Use of magnetic resonance imaging for the investigation
of orbital disease in small animals. J Small Anim Pract
2000;41:145–155.
38. Penninck D, Daniel GB, Brawer R, Tidwell AS. Cross-sectional
imaging techniques in veterinary ophthalmology. Clin Tech Small
Anim Pract 2001;16:22–39.
39. Calia CM, Kirschner SE, Baer KE, Stefanacci JD. The use of
computed tomography scan for the evaluation of orbital disease in
cats and dogs. Vet Comp Ophthalmol 1994;4:24–30.
40. Gilger BC, Whitely RD, McLaughlin SA. Modified lateral orbi-
otomy for removal of orbital neoplasms in two dogs. Vet Surg
1994;23:53–58.
Can Vet J Volume 47, March 2006