Late Liver Metastases of Choroidal Melanoma Detected by Laparoscopy

Choroidal melanoma represents the primary intraocular malignancy in adults with a reported incidence of about 4000 cases per year. The liver is the sole site of metastases in more than 80% of cases and is affected in up to 90% of patients who develop metastatic disease. Patients with metastatic melanoma have usually a median survival of 6 months. In the present paper, the case of a 42-year-old woman with choroidal melanoma who underwent surgery and was followed up for 7 years with no evidence of relapse is reported. Eight months later she had a car accident and was admitted to the hospital complaining of abdominal pain, lack of appetite and asthenia. At physical examination, jaundice and hepatomegaly were found. Abdominal ultrasonography revealed the presence of several hypoechoic lesions, and liver function was compromised due to coagulation deficiency. Thus, the diagnosis of metastatic choroidal melanoma was obtained by video-assisted laparoscopy that showed disseminated darkly pigmented lesions on the surface of the liver. The patient died of liver failure three months later. At autopsy, histopathological examination of the liver confirmed the diagnosis, excluding local recurrence of the choroidal melanoma.