Diffuse Iris Melanoma

A patient presented for evaluation of multiple melanocytic lesions of the right iris that were noticed a few months prior. She was found to have a visual acuity of 20/25 in the right eye and 20/20 in the left eye, with intraocular pressures of 19mmHg in both eyes. Slit lamp examination was notable for several melanocytic lesions in the iris 360 giving the appearance of heterochromia, extending to the periphery especially at 3:00 and 6:00. Gonioscopy revealed invasion of the angle. Ultrasound biomicroscopy showed a diffuse melanocytic lesion with nodular component at 3:00 and thickness of 1.4mm, and smaller convex component at 6:00 measuring 1.0mm in thickness. These findings were consistent with diffuse iris melanoma of the ring variant. The patient receivedtreatment with customized plaque brachytherapy in conjunction with radiation oncology, with harvest of autologous limbal stem cells due to the high risk of limbal stem cell deficiency.Three days later the plaque was removed and placement of the autologous limbal stem cells with amniotic membrane was performed. Fine needle aspiration biopsy for prognostication of the lesion was performed which showed atypical spindle-shaped melanin containing cells. Post-operatively at 6 months, the tumor showed satisfactory regression from radiation and decrease in thickness on ultrasound biomicroscopy, and a clear cornea. She will receive yearly liver ultrasound and chest x-ray for metastatic surveillance.

Presentation Date: 10/13/2022

Issue Date: 11/18/2022