Bilateral breast metastases from choroidal melanoma

PURPOSE: To report an unusual case of solitary sequential bilateral breast metastases from choroidal melanoma. METHOD: Case report. RESULTS: A 48-year-old woman with a large choroidal melanoma in the left eye was treated with Iodine-125 brachytherapy and responded satisfactorily with decrease in tumor thickness. Thirty-seven months after treatment, she developed a solitary, circumscribed melanoma metastasis to the right breast, and 54 months after treatment, a similar metastasis was detected in her left breast. Both breast tumors were managed with lumpectomy. Systemic examination including magnetic resonance imaging of abdomen, chest, and head have been performed regularly and have been normal. At 61 months after treatment, the patient has no clinical evidence of metastatic disease elsewhere. CONCLUSIONS: Uveal melanoma rarely metastasizes to breast tissue. A breast nodule in a patient with a history of uveal melanoma is most likely a primary breast tumor but may rarely represent a metastasis from uveal melanoma.     

Simultaneous bilateral primary choroidal melanoma

The first published case from Norway of primary bilateral malignant melanoma of the choroid is presented. On the admission of a 73-year-old woman for a choroidal melanoma of the left eye, an asymptomatic tumour was detected in the periphery of her right eye. The left eye was enucleated. Histology confirmed the presence of a choroidal melanoma of the mixed type. After 3 1/2 years with regular follow-ups growth of the asymptomatic tumour was noticed. The fast growth was accompanied by a haemorrhage in the vitreous and a secondary retinal detachment. External radiation with a dose of 33.6 Gy resulted in a regression of the tumour, improvement of visual acuity to 0.5 and re-attachment of the retina, lasting the remaining 8 months of life. Multiple metastasis to the liver caused her death.     

Bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy: a report of three cases

PURPOSE: To report three cases of bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy. METHODS: Retrospective, single-center case series. RESULTS: Case 1: In 1981, a 50-year-old man was diagnosed with a 5-mm-thick choroidal melanoma in the right eye (OD) and treated with plaque radiotherapy. In 1994, a 6.8-mm-thick choroidal melanoma in the left eye (OS) was treated with plaque radiotherapy. Final visual acuity was light perception OD and 20/20 OS at 24 years follow-up. Case 2: In 1983, a 53-year-old woman was diagnosed with a 3.5-mm-thick choroidal melanoma OS and treated with plaque radiotherapy. In 2001, an enlarging 2.5-mm-thick choroidal melanoma OD was treated with plaque radiotherapy. Final visual acuity was 20/30 OD and 20/20 OS at 22 years follow-up. Case 3: In 2001, a 92-year-old man was diagnosed with a 7.9-mm-thick choroidal melanoma OD treated with plaque radiotherapy. In 2003, an enlarging 2.8-mm-thick juxtapapillary choroidal melanoma was treated with plaque radiotherapy. Final visual acuity was 20/70 OD and 20/60 OS at 2.5 years follow-up. No patient showed ocular melanocytosis. Stable tumor regression was achieved in all six eyes. Metastatic disease did not develop in any case over 16 years of follow-up. CONCLUSIONS: Monitoring of both eyes of patients with uveal melanoma is important for the remote possibility of melanoma in the second eye. In these three patients, plaque radiotherapy allowed for preservation of the globes and some vision.     

Bilateral rhegmatogenous retinal detachment associated with unilateral choroidal melanoma

A patient with bilateral rhegmatogenous retinal detachment associated with a unilateral choroidal melanoma is presented. It appears that there is no causative relationship between these two findings in this case. The clinician should be advised that these two phenomena are not as rare as was once thought, and an index of suspicion should be maintained whenever one is evaluating a patient with retinal detachment.     

Vitreous histocytology of primary choroidal malignant melanoma

The cytomorphologic findings of a vitrectomy specimen from the right eye of an 80-year-old woman with an unsuspected primary choroidal malignant melanoma are described. The patient had undergone a closed vitrectomy because of chronic vitreous hemorrhage. Histocytology of the vitreous fluid specimens revealed melanoma cells of variable shape and size (from 30-150 microns) with eccentric nuclei. Many of these cells were binucleated or multinucleated with small, uniform, evenly dispersed intracytoplasmic melanin granules. The histocytologic findings together with the postoperative tumor characteristics by ultrasonography and fluorescein angiography suggested the diagnosis of choroidal malignant melanoma.     

Sequential development of bilateral primary choroidal melanoma

PURPOSE: A case of a woman who had bilateral choroidal melanoma diagnosed sequentially 20 months apart and managed conservatively is described. METHODS: The first eye having a juxtapapillary melanoma was treated with a notched episcleral radioactive plaque. The second eye, initially containing a small nevus with unequivocal rapid growth, was managed with diode laser transpupillary thermotherapy. RESULTS: Both tumors regressed considerably following treatment and the patient retained good visual acuity in both eyes. No other malignancies or metastasis were detected during the follow-up period. CONCLUSIONS: A small choroidal nevus rapidly grew after treating a choroidal melanoma in the fellow eye. Close follow-up of such patients is mandatory. Also, conservative treatment should be opted whenever possible given the unpredictable course of the opposite melanocytic lesion.     

Transpupillary thermotherapy for choroidal melanoma.

The management of choroidal melanomas depends on many factors, most importantly, tumor size and location. Small choroidal melanoma in the posterior fundus is amenable to treatment options such as enucleation, radiotherapy, laser photocoagulation, and transpupillary thermotherapy or a combination of these methods. Transpupillary thermotherapy is a technique of tumor heating by infrared radiation delivered through the pupil into the tumor. This method causes dramatic tumor necrosis in choroidal melanomas up to 4 mm in thickness. With properly selected small choroidal melanomas, tumor control is approximately 94%. The heat induces cellular damage at the site of treatment with few remote side effects; therefore, complications are generally limited to the site of treatment and include retinal vascular obstruction (23%), retinal traction (20%), retinal neovascularization (6%), and retinal hole with detachment (< 1%). Tumors located temporal to the foveola demonstrate a statistically higher risk for retinal traction than those located in other quadrants. Tumors near the optic disk demonstrate a higher incidence of retinal neovascularization due to heat-induced obstruction of a major retinal vascular arcade. Overall, vision preservation is satisfactory after thermotherapy for choroidal melanoma, with more than 50% of patients maintaining the same or better vision after treatment, depending primarily on tumor location. In summary, small choroidal melanomas can be controlled with transpupillary thermotherapy, especially those near the optic disk and foveola in areas that are otherwise difficult to irradiate. Longer follow-up is necessary to assess for local recurrence and the impact of treatment on life prognosis.     

Focal fluorescence of choroidal melanoma.

The surface of the tumours of four patients with apparently dormant small choroidal melanomas showed a distinct, localised, hyperfluorescent zone by fluorescein angiography. It was interpreted as being secondary to atrophy of the retinal pigment epithelium. In each patient later growth of the tumour was evidenced by its eruption through Bruch's membrane at this same site. This angiographic finding may predict a tumour that is prone to grow and break through Bruch's membrane at that location.     

Cavitary choroidal melanoma

CASE REPORT: We report an unusual case of cavitary choroidal melanoma. The results of ultrasonography, magnetic resonance imaging, computed tomography, and immunohistochemical studies are presented for a 38-year-old woman who developed an amelanotic tumor in the posterior choroid. B-scan ultrasonography disclosed intratumoral cavitations. Systemic and extraocular extension studies were negative. Enucleation was performed and histopathologic examination showed a choroidal melanoma of spindle cell type, with intratumoral cavitations lined by flattened tumor cells.COMMENTS: The majority of previous reports of intraocular cavitary tumors describe cavitary ciliary body tumors. Uveal melanoma should be included in the differential diagnosis of choroidal cavitary lesions. As far as we know, this is the second documented clinicopathologic correlation of a cavitary choroidal melanoma.