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The authors present the unique case of retinoinvasive melanoma following treatment of choroidal melanoma with brachytherapy. Uveal melanoma, the commonest intraocular malignancy in adults, presents as a pigmented mass in the choroid, ciliary body, or iris. A 79-year-old Caucasian male first presented in 2016 with a left inferotemporal choroidal melanoma that was managed with ruthenium-106 plaque brachytherapy at a Scottish ocular oncology centre in Glasgow. His past medical history included: atrial fibrillation managed with warfarin and bilateral primary open angle glaucoma managed with topical Bimatoprost. Monitoring with serial B-scans demonstrated a reduction of tumour height to <2mm. At a later follow-up, multifocal macular, peri-papillary, and nasal periphery pigmentary changes were noted along with a clinically and radiologically stable choroidal melanoma. After a missed appointment, at the next appointment in November 2018, the patient complained of a “black spot” in his left eye vision. On examination: visual acuity was down to counting figures OS and significant growth in the pigmented areas reported from a previous appointment were found. With a suspected uveal melanoma recurrence an enucleation was carried out. The patient remained well postoperatively and at the latest recorded follow-up with no evidence of metastasis or recurrence. The authors discuss various possible mechanisms for the retinoinvasive melanoma and suggest two plausible mechanisms. Either due to transvitreal invasion of the melanoma or retinal metastasis from the treated malignancy which they justified by comparing the histology of the choroidal melanoma to the secondary foci. Lastly, the authors highlighted the paucity of reported cases on retinoinvasive melanoma and the lack of any previous reports of retinal metastasis from an ipsilateral choroidal melanoma.

Multifocal intraretinal tumour deposits following treatment of an ipsilateral choroidal melanoma.
Jamison A, Connolly J, Cauchi P, et al.
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Annes Ahmeidat

MBChB, BSc, Ninewells Hospital and Medical School, Dundee, UK.

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