Multiple Uveal Melanoma

Abstract

Introduction: Multiple uveal melanoma is a rare occurrence and includes bilateral melanoma, unilateral multiple/multifocal melanoma, or melanoma with metastasis to the ipsilateral or contralateral eye. Methods: A chart review of patients diagnosed with uveal melanoma between January 2013 and January 2019 at the Duke University Eye Center Ophthalmic Oncology Service was performed. Results: Three patients with multiple, sequential melanoma were identified; patient 1 had bilateral choroidal melanoma and patients 2 and 3 had 2 choroidal melanomas occurring in the same eye. In all 3 patients, both the first and sequential choroidal melanomas were treated with I-125 radioactive plaque brachytherapy (PBT). Two patients were found to have developed secondary metastatic uveal melanoma as a presenting sign of systemic metastases. Patient 4, initially treated with PBT, was diagnosed with ipsilateral metastatic choroidal melanoma, also treated with PBT. Patient 5 had right eye enucleation for choroidal melanoma and developed vision-threatening me-tastasis in the left eye, which was treated with PBRT. None of the patients had history of cancer prior to their first diagnosis. Patients 1 and 5 were tested with a systemic melanoma panel; both were negative for BAP1, but patient 1 had a variant of unknown significance in BRCA2. Patient 3 had oculodermal melanocytosis, an established risk factor of uveal melanoma. Conclusion: Although rare, the possibility of multiple uveal melanoma does exist. Examination of the treated and contralateral eye on a regular basis is crucial, not only to identify local failure but also new metastases from the primary tumor and additional primary tumors.

Preliminary Results of Uveal Melanoma Treated With Iodine-125 Plaques: Analysis of Disease Control and Visual Outcomes With 63 Gy to the Target Volume

“…They were excluded if they had metastatic disease at presentation or if they had multiple uveal melanomas, which were previously reported in a case series by Kheir et al. 17 Relevant information consisting of patient demographics, tumor characteristics, treatment data, eye plaque characteristics, oncologic outcomes (local control and distant metastasis), VA, and radiation-related toxicity data were abstracted from the electronic medical record (Maestro/EPIC and ARIA RadONC).…”

Unilateral Multifocal Choroidal Melanoma with Underlying Isolated Choroidal Melanocytosis

“…One published retrospective study found the metastasis-related mortality rate of patients with primary uveal melanoma associated with ocular melanocytosis to be substantially higher than that of patients with similar tumors not associated with this condition [3]. A few case series have described 2 independent melanomas associated with ocular melanocytosis [4][5][6][7][8], and 1 case of 3 independent melanomas in the context of oculodermal melanocytosis has been reported [9]. As a result, patients with ocular melanocytosis are routinely screened for the development of uveal melanoma.…”