Choroidal Melanoma Complicated by Scleritis
Section outline
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A patient with a history of hypercholesterolemia, no personal history of cancer, and a family history of cranial angioma presented initially to optometry endorsing a visual disturbance. The patient was referred to a community retina specialist and then to BPEI for suspected uveal melanoma. Visual acuity upon presentation to BPEI was 20/60 in the right eye and 20/25 in the left eye, with an inferotemporal visual field defect in the right eye. Exam and multimodal imaging was notable for a superior mixed pigment choroidal lesion with overlying retinal hemorrhage and exudative retinal detachment abutting the optic nerve for 5 clock hours with a meridian at 12:30. An inferior dependent exudative retinal detachment was also appreciated with subretinal fluid tracking to the macula. B-scan was notable for a very large untreated lesion at 2 o’clock that was vascular with possible shallow exudative retinal detachment running along sides of lesion. The lesion was associated with a high amount of choroidal excavation along diffuse distension of Tenon's space. The patient was presumptively diagnosed with a juxtapapillary choroidal melanoma, and a management plan was created involving I-125 plaque brachytherapy, fine needle aspiration biopsy, and staging, however, the patient developed a pneumothorax and pulmonary embolism, was admitted to the hospital, and was lost to follow up for four months. The patient represented with LP vision, elevated intraocular pressure, and scleritis in the setting of tumor necrosis. Interval worsening in tumor size and excavation and characteristic T-sign on B-scan associated with scleritis were appreciated. Due to the rapid progression, decision to proceed with enucleation was made. Molecular testing was notable for Class 2 PRAME positivity.
Presentation Date: 12/18/2025
Issue Date: 03/20/2026
