Primary cutaneous malignant melanoma metastatic to the iris.

Abstract

SUMMARY We describe a case of cutaneous malignant melanoma metastatic to the iris as the first presenting sign of metastases 10 years after excision of the primary tumour. The histology of the excised iris metastases and the primary skin melanoma are compared. Progressive intracranial metastatic growth did not correlate with the observed regression of the residual intraocular melanoma cells during cyclical cytotoxic therapy.Iris metastases from primary cutaneous malignant melanomas are rare, with only 4 pathologically proved cases (Wagenmann, 1900;Adamuk, 1909;Font et al., 1967). One case describing the response of intraocular cutaneous-melanoma metastases to cytotoxic agents has been reported (Stark et al., 1971). Our case illustrates a 10-year metastasis-free interval after primary cutaneous tumour excision and then seeding only to the distribution of the internal carotid artery. The intracranial metastases progressed despite the dramatic regression of residual metastatic intraocular tumour cells in response to cytotoxic therapy. Case reportA 26-year-old white woman presented in November 1975 with a 5-week history of blurred vision in her left eye and accompanying headaches. On examination her visual acuity was 6/4 and 6/5 in the right and left eye respectively. There was a pale, fleshy mass of 2 mm diameter in the anterior stroma of the iris superonasally in the left eye. It was situated at the collarette and slightly peaked the pupil in this quadrant. Many large pigmented cells were circulating in the anterior chamber, and similar cells were distributed in a fern-like pattern on the anterior lens capsule and on the central corneal endothelium. Applanation tonometric pressures were 17 mmHg in both eyes, and both angles were grade 4'4 on gonioscopy, with no abnormal pigmentation present. The vitreous and fundus were normal.Physical examination revealed a skin graft on the left scapular area and no clinical evidence of meta-

Ocular and orbital metastasis of cutaneous melanomas

“…The area where a cluster of melanoma cells was deeply seated in the iris stroma could well be the primary site of the iris metastasis. Histology of a small circumscribed melanoma metastasis in the iris has been reported [18]. Spreading tumour had also covered chamber angle, posterior iris surface, lens capsule, ciliary processes, zonular fibres, and vitreous, as has also been found by Font et al [2].…”

“…Of the uvea the choroid is most frequently affected, location in the ciliary body is less common, metastasis to the iris, as in our first patient, is rather rare with only 13 eyes reported. Wagenmann [12], Adamiik [13] [4], and Hirst et al [18], each reported on one eye. De Bustros et al [19] reported on 2 unilateral and 1 bilateral case.…”

Bilateral orbital metastases from breast carcinoma masquerading as thyroid eye disease

“…This report therefore emphasises the fact that the eye can be the initial site of a clinically identifiable recurrence of cutaneous malignant melanoma 6 , 8 and that ocular symptoms can develop up to 10 years after the excision of the primary tumour. 8 Treatment of cutaneous malignant melanoma metastatic to the viscera and eye is usually palliative, and consists of a combination of external beam radiotherapy and chemotherapy. Enucleation was required in this case as the tumour had become extensive, resulting in a blind painful eye.…”

Coincidence of Primary Malignant Melanoma of Skin and Eye

“…In the 3rd case no such predis position was found [2]: a malignant melano- ma of the lip with regional lymph node metastases was followed by a diffuse choroidal malignant melanoma 7 years later. In fact, first a new metastasis was suspected clinical ly, and indeed at least 34 such cases have been reported so far [8], Yet the histological examination demonstrated the ocular lesion to be a primary one. In our case the situation is different: the cutaneous lesion turns up about 6 years after the detection of the oc ular one and is diagnosed another 3 years lat er.…”