More than Meets the Eye: Metastatic Uveal Melanoma.

Abstract

A 61-year-old man with subacute, abdominal distension presented to the Emergency Department. He also had progressive left eye pain and vision loss for 3 years. Physical examination revealed hepatomegaly and a left afferent pupillary defect. Left intraocular pressurewas elevated at 34mmHg. Ultrasound demonstrated a large mass filling 80 % of the left globe with low-internal reflectivity consistent with uveal melanoma. The left eye had florid iris neovascularization (arrow, Fig. 1) resulting from tumor secretion of vascular endothelial growth factor and prominent sentinel vessels (dotted arrow, Fig. 2) nourishing a tumor infiltrating the uvea (solid arrow, Fig. 2). Most of these findings could be appreciated with penlight examination. Abdominal computed tomography revealed hepatomegaly with hepatic masses, biopsy of which revealed metastatic melanoma. Uveal melanoma is the most common primary ocular malignancy in adults. Since liver is the most common site of metastasis, metastatic uveal melanoma can present with vision loss and liver masses. In the U.S., the incidence of uveal melanoma is 4.3 cases per million people; the average age at diagnosis is 60 years. Once metastasis occurs, survival is under one year, and no cure exists. Our patient died the following week on home hospice.