Choroidal Metastases from Cutaneous Melanoma

A patient with history of cutaneous melanoma presents with worsening vision of the right eye over a period of a few weeks. His exam was notable for visual acuity of 20/40 in the right eye and 20/25 in the left eye. Intraocular pressure was 18 in both eyes. Slit lamp exam was unremarkable. The dilated fundus exam was notable for a choroidal melanocytic lesion in the macula of the right eye with associated subretinal fluid and orange pigment, and unremarkable posterior segment in the left eye. Macula OCT shows subretinal fluid as well as an elevated choroidal lesion, and B scan with quantitative A-scan showed a dome-shaped choroidal lesion with medium to low internal reflectivity and average height of 2.2mm. Prior to presentation, patient had wide local excisions of arm melanoma, and more recently found to have extranodal extension of forehead melanoma as well as new jaw lesions positive for melanoma. The patient subsequently received systemic imaging which showed evidence of diffuse metastases of cutaneous melanoma in the liver, lungs, and brain. Further pathologic analysis was notable for negative BRAF mutation. Immunotherapy with checkpoint inhibitors, specifically combination of nivolumab and ipilimumab was started. After 4 infusions of checkpoint inhibitor therapy, the right eye choroidal lesion substantially regressed and the tumor became unmeasurable on OCT and B scan Ultrasound. The vision improved to 20/30 in the right eye. There have been no new visual symptoms to report. The patient is planned to undergo potential stereotactic radiosurgery due to new enhancing brain lesions.

Presentation Date: 06/01/2023

Issue Date: 06/23/2023