Bilateral choroidal metastases as presentation of dissemination of cutaneous malignant melanoma

Abstract

Case Report. A 47-year-old man presented with blurred vision in the right eye. Ophthalmoscopic examination showed several placoid, pigmented lesions in the posterior pole and midperiphery of the retina of both eyes. Results. Patient referred a cutaneous malignant melanoma on the back skin removed 6 years ago. A systemic workup revealed multiple metastases in liver and spleen. After an exhaustive study we concluded that it was a dissemination of a cutaneous malignant melanoma with bilateral choroidal metastases, liver and spleen metastases. The patient obtained clinical ocular improvement after palliative chemotherapy, although he died in the following months. Pathological examination of the lesions confirmed the diagnosis of choroidal metastases from a malignant cutaneous melanoma. Conclusions. Monitoring patients who have had cutaneous malignant melanoma is very important, since melanoma metastases may occur even many years after the diagnosis of the primary tumor. Choroidal metastases from cutaneous melanoma are uncommon but we should be aware because their appearance worsens prognosis.

Choroidal metastases: Origin, features, and therapy

“…[ 4 5 10 ] Rare primary carcinomas are metastasizing to choroid include tumors arising from the submandibular gland, thyroid, contralateral choroid, testes, ovaries, urothelial tract, neuroendocrine tumor, and sarcoma. [ 5 7 8 9 10 17 18 19 20 21 22 ] Most patients with choroidal metastasis have known systemic cancer at the time of eye diagnosis, but in 34% of cases, the choroidal metastasis precedes diagnosis of systemic cancer. Of those without known cancer, the primary tumor sites included lung cancer (7%), breast cancer (35%), and about 50% of patients with the primary site not found.…”

“…External beam radiotherapy (EBRT) at a dosage of 40-60 Gy causes tumor regression in 85-93% of patients with vision improvement or stabilization in 56% of eyes. [ 19 45 46 47 48 ] However, the extended treatment period of EBRT makes the treatment inconvenient and impractical in critically ill-patients with poor life prognosis. Radiation related complications include cataract (7%), radiation retinopathy (3%), exposure keratopathy (3%), optic neuropathy (2%), and neovascularization of iris (2%).…”