Orbital and skull metastases as the initial presentation of lung adenocarcinoma harbouring a MET exon 14 skipping mutation

A man in his 70s presented with right ocular pain, visual disturbance, forehead swelling and left iliac pain. Diagnostic imaging revealed a large right orbital–frontal mass with skull involvement, a cavitary lesion in the right upper lobe and a left iliac lesion. Histological and molecular analyses confirmed lung adenocarcinoma with a MET exon 14 skipping mutation. Initial management focused on symptom control via palliative radiotherapy to the orbital and iliac lesions which achieved rapid relief. Following molecular confirmation, tepotinib—a selective MET tyrosine kinase inhibitor—was initiated. This resulted in clinical stability and a slight radiographic reduction of the primary lung lesion. This case highlights an atypical clinical manifestation of orbital metastasis in MET-mutated non-small-cell lung cancer. It underscores the clinical necessity of prompt tissue diagnosis and molecular profiling in patients presenting with atypical metastatic sites to facilitate the timely initiation of targeted systemic therapies.