Cutaneous malignant melanoma metastasis to pseudophakic lens
Reviewed by Annes Ahmeidat

Metastases to the eye and orbit are rare and intraocular cutaneous malignant melanoma metastasis (ICMM) is exceedingly rare, representing around 5%. There have only been three previous cases of ICMM to the lens in the literature, all of which presented in painful blind eyes and were diagnosed by enucleation. However, the authors in this case report present a different presentation of an 80-year-old man with a comfortable, seeing, pseudophakic eye. An incidental finding of anterior uveitis was caught during a routine follow-up for regressed peripapillary choroidal neovascular membrane as his vision was reduced from his baseline of 6/6 to 6/9. His past medical history included: left amblyopia, bilateral pseudophakia, cutaneous malignant melanoma of left groin three years ago and previous treatment of choroidal neovascular membrane in right eye with ranibizumab injections. A previous history of metastasis to regional lymph nodes, bladder wall, and right endobronchial area was noted. No systemic oncological treatment had been administered and he is under surveillance with periodic computer tomography scanning of the chest, abdomen and pelvis. After deteriorating, despite standard treatment of suspected right anterior uveitis, there was a further drop in vision and a suspicion of masquerade syndrome considering the atypical course. Following a fall in vision to hand movements, a pars plana vitrectomy and surgical posterior capsulotomy helped confirm the histological diagnosis of metastatic cutaneous melanoma on a granulomatous inflammatory background. Cutaneous melanoma generally spreads haematologically; however, the lens capsule is avascular. The authors believe there was an initial spread to the humorous, a common site, and thereafter free-floating malignant cells adhered to the capsule and began proliferating. This case has broadened our understanding of ICMM and the capability of diagnosis and therapeutic options with vitrectomy in comparison with enucleation by previous authors.

Cutaneous malignant melanoma metastasis to the pseudophakic lens capsule with associated granulomatous intraocular inflammation.
Quhill H, Mudhar HS, Cornish KS, Rennie IG.
OCULAR ONCOLOGY AND PATHOLOGY
2020;6:339-43.