Drew-Bear Laura E, Drummond Allison, Truong Crystal, Desai Komal
Department of Ophthalmology, University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA.
Case Rep Ophthalmol. 2025 Apr 24;16(1):360-365. doi: 10.1159/000544926. eCollection 2025 Jan-Dec.
Approximately 5% of patients with cutaneous melanoma develop distant metastases, and very rarely, can involve the eye and orbit. This case report discusses a patient with an unusual presentation of choroidal metastasis secondary to cutaneous melanoma.
A 76-year-old man with a past medical history of cutaneous melanoma on the right shoulder status post radiation presented to the ocular oncology clinic with a 3-month history of decreased vision, occasional pain, and floaters in the right eye. Initial examination revealed a visual acuity of hand motion in the right eye, intraocular pressure of 5 mm Hg, and no view to the fundus due to vitreous hemorrhage. B-scan did not show a retinal tear, retinal detachment, or intraocular tumor. The patient underwent pars plana vitrectomy of the right eye where massive choroidal thickening with subretinal yellow deposits obstructing the optic nerve head was seen, initially concerning lymphoma. On postoperative week one, visual acuity remained hand motion and the fundus exam showed clear vitreous and retinal/choroidal infiltrates obscuring the optic nerve and macula. Repeat B-scan showed retinal and choroidal thickening with exudates. Cytology results from surgery later revealed malignant cells consistent with melanoma. The patient underwent ocular radiation but eventually progressed to no light perception visual acuity. He is currently under observation with the goal of palliative care.
This case highlights the importance of maintaining a high level of suspicion for metastasis in the setting of melanoma history even when presentation can be atypical. Early recognition of choroidal metastasis allows for timely intervention, improving the chances of preserving vision.
约5%的皮肤黑色素瘤患者会发生远处转移，极少情况下会累及眼和眼眶。本病例报告讨论了一名皮肤黑色素瘤继发脉络膜转移的不寻常表现患者。
一名76岁男性，既往有右肩部皮肤黑色素瘤放疗史，因右眼视力下降3个月、偶有疼痛和飞蚊症就诊于眼科肿瘤门诊。初始检查发现右眼视力为手动，眼压5毫米汞柱，因玻璃体积血无法看清眼底。B超未显示视网膜裂孔、视网膜脱离或眼内肿瘤。患者接受了右眼玻璃体切除术，术中可见脉络膜大量增厚，视网膜下黄色沉积物阻塞视神经乳头，最初怀疑为淋巴瘤。术后第1周，视力仍为手动，眼底检查显示玻璃体清晰，视网膜/脉络膜浸润遮挡视神经和黄斑。重复B超显示视网膜和脉络膜增厚伴渗出。手术的细胞学结果后来显示恶性细胞与黑色素瘤一致。患者接受了眼部放疗，但最终进展为无光感视力。他目前正在接受观察，目标是姑息治疗。
本病例强调了即使表现不典型，在有黑色素瘤病史的情况下对转移保持高度怀疑的重要性。早期识别脉络膜转移可及时干预，提高保留视力的机会。
