Uveal Melanoma Metastasis to the Contralateral Eye Structures: A Retrospective Comparative Analysis of 13 Consecutive Patients

Abstract

To report uveal melanoma (UM) metastasis to the contralateral ocular and periocular structures. Retrospective study. Thirteen patients with UM metastasis to the contralateral ocular and periocular structures were included. Clinical records were reviewed retrospectively. The development and time to onset of contralateral ocular and periocular metastasis, systemic metastasis, and death. Of the 13 000 treated UM patients, 13 patients were diagnosed with UM metastasis to the contralateral ocular and periocular structures. Mean patient age at primary UM diagnosis was 60 years (median, 60 years; range, 37-87 years). The primary uveal melanoma was in the choroid (n= 11) or ciliary body (n= 2) and was treated with brachytherapy (n= 11), proton beam radiotherapy (n= 1), or enucleation (n= 1). Systemic metastasis developed in 11 patients (85%) at a mean of 66 months (median, 34 months; range, 12-216 months) after diagnosis of the primary UM. All 11 patients (100%) showed liver metastasis and 8 patients (62%) also showed extrahepatic metastasis. The sites of metastasis to the contralateral ocular or periocular structures included the choroid in 4 patients (31%), the orbit in 7 patients (54%), and the eyelid in 2 patients (15%). One patient with eyelid metastasis demonstrated concurrent conjunctival nodule. Mean time to diagnosis of contralateral ocular or periocular metastasis was 94 months (median, 48 months; range, 9-375 months). Contralateral choroidal metastasis was multifocal in 3 of 4 patients (75%). Of 7 patients with orbital metastasis, 5 showed extraocular muscle involvement with restricted ocular motility. Treatment for contralateral choroidal metastasis included brachytherapy (n= 2), transpupillary thermotherapy (n= 1), and observation (n= 1). Treatment for contralateral periocular (orbit or eyelid) metastasis was excision (n= 5), external beam radiotherapy (n= 2), and observation (n= 2). Of 13 patients, death was documented in 11 patients at a mean of 17 months (median, 9 months; range, 3-54 months) as a result of systemic UM metastasis (n= 10) or unrelated cause (n= 1). Metastasis resulting from UM to the contralateral ocular and periocular structures is rare and generally occurs in patients with disseminated metastasis. Orbital tissue is the most common site of involvement, and these patients have short life expectancy.