Cutaneous melanoma with choroidal metastases and response to systemic therapy

Abstract

Introduction: The most common ocular tumours are metastases [1]. They predominantly arise from breast, lungs and gastrointestinal cancers [2]. Metastatic cutaneous melanoma represents less than 5% of ocular and orbital metastases [2]. Cutaneous melanoma is the most common type of melanomas with incidence rate of 10.2 cases per 100 000 people in Europe [3]. Melanoma develops from uncontrollably proliferating melanocytes and is responsible for 5 % of all cutaneous malignancies [4]. Lungs, liver and brain are the most common metastastic sites while ocular involvement is rare [5]. Choroid is often affected due to good vascularisation, metastases are more aggressive than primary uveal melanomas [1]. Initial treatment consists of excision of primary cutaneous melanoma and lymph nodes with metastases. Systemic therapy is used to prevent tumour spreading and shows good results [1]. Methods: Presentation of clinical findings and imaging of a patient with cutaneous melanoma with choroidal metastases. Case: A 41-year-old woman presented with a month of progressive blurry vision in left eye. She had a surgical melanoma excision in her back two years ago. One year and eight months after the surgery metastases in axillary lymph nodes were detected and removed. After lymph nodes excision the patient was treated with interferon 3 times per day. On ophthalmological examination three months later her corrected visual acuity was 0.4 in the left eye and an elevated pigmented choroidal lesion with associated retinal detachment in the fundus of left eye was revealed. After the diagnosis of ocular metastases, treatment with vemurafenib and cobimetinib was started and vision acuity with fundus examination showed improvement after one month of treatment. One year later this treatment was changed to nivolumab because subcutaneous and brain metastases were detected[...].