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Hopkins NS, Kornblau IS, Montes-Sabino CE, Boom A, Wilson MW. Delayed recurrence of an iridociliary malignant melanoma 180° from the primary tumor. Am J Ophthalmol Case Rep 2022; 28:101710. [PMID: 36262689 PMCID: PMC9574778 DOI: 10.1016/j.ajoc.2022.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose We report the case of a 66-year-old female who returned with a rare recurrence of iridociliary melanoma 180° from the original lesion. Observations Upon initial presentation eleven years prior, a pigmented iris lesion suspicious for primary uveal melanoma was noted in the right eye at 9 o'clock. After one year of observation, inferior growth of the iris lesion prompted treatment via primary iridectomy with excisional biopsy and pupilloplasty. Postoperative biopsy confirmed spindle B type melanoma with epithelial foci, and adjuvant brachytherapy was performed to treat the reported positive anterior ciliary body involvement. Ten years after initial plaque brachytherapy treatment, the patient returned with a pigmented iris lesion in the right eye at 3:30–5 o'clock, which was treated with enucleation. On pathology, the new melanoma was predominantly epithelioid, consistent with a transformed recurrent iridociliary melanoma. The patient remains metastasis free 13 years after initial diagnosis. Conclusions and importance This case describes a rare, late recurrence of an iridociliary melanoma 180° away eleven years after initial presentation, emphasizing the importance of lifelong follow-up for patients with iridociliary melanoma. This rare form of recurrence has not been previously reported in the literature. We hypothesize the original lesion contained radiotherapy resistant epithelioid cells which grew superficially on the posterior iris and anterior ciliary body, ultimately breaking back through the anterior iris 180° away.
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Affiliation(s)
- Nikolas S. Hopkins
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ilyse S. Kornblau
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Surgical Services, Ophthalmology Section, Veterans Health Administration, Memphis, TN, USA,Corresponding author. Department of Ophthalmology Hamilton Eye Institute, University of Tennessee Health Science, Center 930 Madison Ave Memphis, TN, 38103, United States.
| | - Christopher E. Montes-Sabino
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alan Boom
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Matthew W. Wilson
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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Stiefel HC, Miller A, Wilson DJ, Albert DM. Recurrent melanoma arising from sclera. Am J Ophthalmol Case Rep 2022; 27:101562. [PMID: 35677815 PMCID: PMC9168120 DOI: 10.1016/j.ajoc.2022.101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To report a case of recurrent malignant melanoma suspected to have arisen from intrascleral melanocytic cells. Observations En bloc removal of melanoma was performed with iridocyclectomy in a 46-year-old Caucasian male. Histopathologic examination confirmed a diagnosis of malignant melanoma in the subconjunctival space, which was presumed to have arisen from the sclera and extended both intraocularly and subconjunctivally. 15 years later, a pigmented limbal lesion near the site of the previous iridocyclectomy was excised by lamellar sclerectomy. Histopathology showed a proliferation of pigment-containing cells with atypical nuclei consistent with recurrent melanoma. Conclusions and Importance We report a case of recurrent melanoma that we suspect arose from intrascleral melanocytes, extended both intraocularly and subconjunctivally, and recurred 15 years following initial excision.
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Affiliation(s)
- Hillary C. Stiefel
- Oregon Health & Science University, Department of Ophthalmology (Casey Eye Institute), 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Audra Miller
- Oregon Health & Science University, Department of Ophthalmology (Casey Eye Institute), 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - David J. Wilson
- Oregon Health & Science University, Department of Ophthalmology (Casey Eye Institute), 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Daniel M. Albert
- Oregon Health & Science University, Department of Ophthalmology (Casey Eye Institute), 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
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Menicacci C, Al-Jamal RT, De Francesco S, Barchitta M, Girolamo M, Di Maggio A, Hadjistilianou T. Very late orbital recurrence of choroidal melanoma four decades post enucleation. Eur J Ophthalmol 2021; 32:NP88-NP93. [PMID: 33706580 DOI: 10.1177/11206721211001266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Orbital recurrence of malignant choroidal melanoma is quite uncommon, occurring in about 3% of patients undergoing enucleation for large tumors. Orbital recurrences after more than 10 years from enucleation are even rarer. In literature, only few reports described orbital recurrence that occurred between 10 and 40 years after primary diagnosis. Herein we report a very late choroidal melanoma recurrence, 40 years post enucleation, of a 52 year-old female who had undergone left enucleation at the age of 12. She presented to our clinic for consultation in 2017, complaining of difficulty to contain the prosthesis, as well as, presence of small pigmented palpable nodules inferiorly in her anophthalmic socket. The patient was not aware of the medical condition which had lead to the enucleation. We requested her medical reports and detailed history through her family. We realized after reviewing her charts 40 years back, that her enucleation was due to malignant choroidal melanoma (CMM). Full screening was performed. After magnetic resonance imaging (MRI), that showed the presence of nodular masses in the anophthalmic socket, an excisional biopsy was performed. Histopathology confirmed the diagnosis of CMM (epithelioid and spindle cell type), supporting the hypothesis that residual melanoma cells may remain clinically dormant for long periods, even for decades. A literature review was performed in order to review similar cases and to understand and discuss multiple factors, which may explain this extremely delayed recurrence. To the best of our knowledge, this is the third case to be reported in the literature.
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Affiliation(s)
- Cristina Menicacci
- Unit of Ophthalmology, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Rana'a T Al-Jamal
- Ocular Oncology Service, Helsinki University Central Hospital, Helsinki, Finland
| | - Sonia De Francesco
- Unit of Ophthalmology, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Matteo Barchitta
- Unit of Ophthalmology, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Matteo Girolamo
- Unit of Ophthalmology, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandro Di Maggio
- Unit of Ophthalmology, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Theodora Hadjistilianou
- Unit of Ophthalmology, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Schmelter V, Heidorn S, Muacevic A, Priglinger SG, Foerster P, Liegl R. Robotic assisted CyberKnife radiosurgery for the treatment of iris melanoma. Sci Rep 2021; 11:5685. [PMID: 33707492 PMCID: PMC7952409 DOI: 10.1038/s41598-021-84290-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/16/2020] [Indexed: 11/09/2022] Open
Abstract
Iris melanoma is a rare form of uveal melanoma with potential metastic spread. Treatment options include surgical resection, enucleation or irradiation. We analysed visual outcome, complication appearance and management in eight patients with iris melanoma following robotic-assisted CyberKnife treatment. Consecutive patients from the Department of Ophthalmology at University of Munich were included in the study if they had an iris melanoma that was treated with CyberKnife and had a minimum follow-up of 12 months. We evaluated tumor thickness, largest diameter, visual acuity and complications. 8 patients were included in this report. The median age was 74 years (range: 53-86 years). The median follow-up was 23 months (range 12-48 months). Tumor thickness decreased from 2.1 to 1.4 mm on average. Four out of eight patients showed stable or increased visual acuity compared to visual acuity at first visit. We did not find a correlation of applied radiation volume or radiation dose on visual outcome. Radiation keratopathy was the most common complication in five patients. No recurrences were noted. Robotic-assisted radiosurgery following CyberKnife is a promising non-invasive, single session treatment option for iris melanoma with comparable results regarding recurrence rate or complications to brachytherapy and proton beam therapy. All included patients showed good visual outcome.
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Affiliation(s)
- Valerie Schmelter
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | | | | | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Paul Foerster
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Raffael Liegl
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany.
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Ndulue JK, Mashayekhi A, Shields CL. Ciliary Body Seeding after Pars Plana Transvitreal Fine-Needle Aspiration Biopsy of Choroidal Melanoma. J Ophthalmic Vis Res 2020; 15:252-255. [PMID: 32308961 PMCID: PMC7151516 DOI: 10.18502/jovr.v15i2.6744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 10/07/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose To report ciliary body seeding 20 years after pars plana transvitreal fine needle aspiration biopsy (FNAB) of choroidal melanoma. Case report 67-year-old man with choroidal melanoma in left eye was previously managed with pars plana FNAB using a 25-gauge needle followed by plaque radiotherapy. Twenty years later, choroidal melanoma was regressed but there was a small flat focus of scleral pigment 3.0mm from the limbus at the FNAB site. Ultrasound biomicroscopy showed a contiguous ciliary body mass measuring 3.1mm in thickness. Tumor seeding in the anterior chamber angle was noted inferiorly. These findings suggested melanoma recurrence along the needle tract. Treatment was performed with Iodine-125 radioactive plaque covering entire anterior segment and ciliary body recurrence. The tumor regressed to 2.2mm over one year. Conclusion Pars plana transvitreal FNAB of choroidal melanoma resulted in needle tract seeding in ciliary body and episcleral region 20 years later.
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Affiliation(s)
| | - Arman Mashayekhi
- Wills Eye Hospital, Ocular Oncology Service, Philadelphia, PA, USA
| | - Carol L Shields
- Wills Eye Hospital, Ocular Oncology Service, Philadelphia, PA, USA
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