Simultaneous metastases of cutaneous malignant melanoma to conjunctiva and choroid

COMMENT Secondary metastatic disease in the eye is rare compared with other sites in the body and simultaneous secondaries in both anterior and posterior segment are highly unusual. 1 The incidence of histopathologically demonstrable cutaneous malignant melanoma metastasising to these sites was seen in five of 15 cases (33%) with disseminated cutaneous malignant melanoma in an necropsy series and is thought to be more common in men. 2 The presentation in the eye has been variously described as ranging from distinct tumours in the fundus or small diffuse infiltrates, anterior uveitis refractory to treatment, iris heterochromia, brownish coloured hypopyon due to tumour cells, diffuse pigmentation of the iris and the lens, aqueous and vitreous seedlings, and conjunctival pigmentation. 3 4 Patients can present with pain and redness due to secondary glaucoma caused by infiltration of the trabecular meshwork or angle closure due to an annular haemorrhagic choroidal detachment. 5 Retinal deposits are very rare and may cause blurred vision. 6 Differentiation between secondary melanomas in the choroid and a primary melanoma is important in order to decide on the type of management. The mode of treatment of metastatic cutaneous malignant melanoma in the eye can range from local excision as in small localised iris tumours, and enucleation for a painful blind eye or palliative treatment comprising chemotherapy and radiotherapy if the disease is widespread, as is often the case. 1 Patients with a single choroidal metastasis may be considered for radioactive plaque treatment. 7 Previous studies have reported a median survival rate of 72 days with a maximum survival of 183 days and less than 10% survive up to 8 months after the onset of ocular symptoms. 2 Although the survival rates are partly related to the depth of the dermal invasion 9 ocular metastases with only superficial spreading type of melanomas have been reported and this was also true of our patient.