Metastatic Cutaneous Melanoma to Choroid

An elderly patient presented with vision loss in the right eye and self-referred to BPEI for a second opinion. A pigmented, elevated choroidal lesion concerning for malignancy was noted in the right eye with sub retinal fluid extending into the macula. The patient had a history of breast carcinoma s/p treatment, cutaneous melanoma, basal cell carcinoma of skin, and squamous cell carcinoma of skin. Systemic workup by outside provider had revealed brain lesion, and radiation therapy had been initiated on brain and globe with presumption of recurrent metastatic breast cancer. Decision was made with patient for intraocular fine needle aspiration biopsy to determine diagnosis prior to continuing radiation therapy. FNAB revealed atypical melanocytes consistent with melanoma of the uvea. Genetic mutations panel revealed BRAF mutation consistent with cutaneous melanoma and no mutations consistent with primary uveal melanoma. The patient was treated with systemic BRAF and MEK inhibitors with regression of choroidal tumor and improvement of vision to 20/30.

Presentation Date: 03/25/2021

Issue Date: 04/02/2021