Thibaud Mathis, MD; Jean-Pierre Caujolle, MD; Juliette Thariat, MD, PhD
A 36-year-old woman presented with visual deterioration and headache. Ophthalmologic examination results showed a 5-mm-thick choroidal mass in her right eye. Head and chest computed tomography scans showed brain and lung metastases. A resection of her lung nodule revealed metastatic BRAF V600–mutated melanoma. The patient underwent systemic targeted therapy followed by 6 sessions of Gamma Knife (Elekta) irradiation for her brain metastases. Ocular Cyberknife (Accuray) stereotactic radiotherapy was performed with a macular- and optic nerve–sparing approach. Despite disease progression in the brain, the abnormal thickness resolved in her eye and her visual acuity increased from 20/200 OD to 16/20 OD at 3 months (Figure).
Ediriwickrema, Lilangi S.; Liu, Catherine Y.; Kikkawa, Don O.; Korn, Bobby S.
The authors describe a clinical case whereby a patient with metastatic cutaneous melanoma developed eyelash poliosis after undergoing treatment with combination immunotherapy with ipilimumab and nivolumab.
Norberto Mancera, Keiran S.M. Smalley, Curtis E. Margo
Cutaneous melanoma, a potentially lethal malignancy of the periocular skin, represents only a small proportion of the roughly 87,000 new cases of cutaneous melanoma diagnosed annually in the United States. Most of our understanding of melanoma of the eyelid skin is extrapolated from studies of cutaneous melanoma located elsewhere. Recent years have witnessed major breakthroughs in molecular biology and genomics of cutaneous melanoma, some of which have led to the development of targeted therapies. The molecular insights have also kindled interest in rethinking how cutaneous melanomas are classified and assessed for risk. We provide a synopsis of the epidemiology, histopathologic classification, and clinical experience of eyelid melanoma since 1990 and then review major advances in the molecular biology of cutaneous melanoma, exploring how this impacts our understanding of classification and predicting risk.
Everett L. · Damato B.E. · Bloomer M.M. · Palmer J.D. · Kao A.A. · Stewart J.M. · Afshar A.R.
Purpose: To report a case of metastatic cutaneous melanoma presenting with choroidal metastasis simulating primary uveal melanoma. Design: Case report. Method: Presentation of clinical, radiographic, histopathologic, and tumor genetic findings in a patient with cutaneous melanoma with choroidal metastasis. Results: A 50-year-old man with a remote history of stage 1A cutaneous melanoma presented with eye pain, peripheral vision loss, floaters, red eye, and choroidal mass that was originally diagnosed as a primary uveal melanoma at an outside institution; however, subsequent imaging and clinical evaluation demonstrated that this choroidal mass was the first manifestation of widely metastatic cutaneous melanoma (liver, pancreas, lung, bone, brain, and orbit lesions). Histopathologic analysis of the tumor after enucleation was consistent with cutaneous melanoma, and tumor genetic testing was positive for BRAF V600E mutation, confirming the choroidal lesion to be a cutaneous melanoma metastasis rather than a primary choroidal melanoma. Conclusions: Metastatic cutaneous melanoma to the orbit or globe occurs rarely. Tumor genetic testing may help differentiate metastatic cutaneous melanoma from primary uveal melanoma in cases where the diagnosis is uncertain, and can also inform therapy and prognostic counseling.
Samantha K. Paul, ScB; Lin Chou, MD; Carol L. Shields, MD
A 71-year-old man with psoriatic arthritis and stage IV cutaneous melanoma presented with iritis in the right eye. Treatment included topical corticosteroids; however, low-grade cellularity persisted, and iritis developed in the left eye. He was receiving pembrolizumab, a systemic checkpoint inhibitor. Checkpoint inhibitors are increasingly used to treat cutaneous melanoma, and these medications can cause uveitis.1 The patient’s chronic bilateral iritis led to posterior subcapsular cataracts, which decreased visual acuity to 20/80 OD and 20/50 OS. Multiple pigmented deposits were visualized on the right anterior lens capsule and iris (Figure, A). A capsulorhexis specimen obtained during cataract surgery revealed melanoma deposits (Figure, B) and established the true cause of pseudouveitis, namely, intraocular metastases from cutaneous melanoma. Cutaneous melanoma rarely metastasizes to the eye.2-4 Visual acuity improved to 20/25 OD after surgery. Abdominal metastases led to death 7 months later.
G Albanese and L C Abercrombie
No abstract available