Abstract
Thyroid metastasis is a rare occurrence with cutaneous melanoma and even more uncommon with uveal melanoma. The management of such metastasis is uncertain due to its infrequency and, in the era of immunotherapy, the effect of these novel drugs on uncommon metastasis, such as to the thyroid, is unknown. We report the rare case of a thyroid metastasis in a patient diagnosed with ocular melanoma initially managed with enucleation. Metastatic disease developed in the lung and thyroid gland. The case patient received the immunotherapy ipilimumab with stable disease in the thyroid and progressive disease elsewhere. The patient was then further treated with a second immunotherapy agent, pembrolizumab, and remains with stable disease one year later. We discuss the current literature on thyroid metastases from all causes and the optimal known management strategies. Furthermore, we provide an original report on the response of this disease to the novel immunomodulators, ipilimumab, and pembrolizumab with stable disease four years after initial diagnosis of ocular melanoma.
Highlights
IntroductionReported incidence ranges from 0.5% to 24.2% in autopsy studies [1,2,3,4,5]
Ocular melanoma comprises 3 to 4% of all malignant melanoma and most commonly metastasizes to the liver [8, 9]. It has only been reported once before in the literature as giving rise to thyroid metastases in 1986 [10]. To add to this scant literature, we report a rare case of thyroid metastasis from uveal melanoma and report a disease response to the systemic immunotherapies in the form of ipilimumab and pembrolizumab
Their development can be distant from the primary diagnosis. This is in the case of renal cell carcinoma, where there have been multiple cases of metastasis developing over twenty years after diagnosis of the primary malignancy [11, 16]
Summary
Reported incidence ranges from 0.5% to 24.2% in autopsy studies [1,2,3,4,5] They most often arise from renal, breast, and lung primaries; cutaneous melanoma is a common site [1, 2, 6]. Ocular melanoma comprises 3 to 4% of all malignant melanoma and most commonly metastasizes to the liver [8, 9]. It has only been reported once before in the literature as giving rise to thyroid metastases in 1986 [10]. To add to this scant literature, we report a rare case of thyroid metastasis from uveal melanoma and report a disease response to the systemic immunotherapies in the form of ipilimumab and pembrolizumab
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