A 56-year-old woman reported into the emergency department with a history of pain and inflammation in her right eye since the past 4 days. However, before presentation, the woman had been blind in the right eye since several years. Clinical examination of the right eye showed relevant afferent pupillary defect, opthalmoplegia, periorbital inflammation and proptosis.
For further investigation, the patient was advised an MRI which revealed a right orbital mass that measured 2.8 cm by 2.5 cm by 2.3 cm with extraocular and intraocular components. In addition, the patient’s alanine aminotransferase and aspartate aminotrasnferase levels were normal. However, an elevation was seen in the level of alkaline phosphatase (245 U per liter; reference range, 31 to 95) and y-glutamyltransferase (225 U per liter; reference range, 7 to 37).
Abdominal and thoracic imaging showed vertebral sclerotic osseous disease, thoracic lymphadenopathy, abdominal lymphadenopathy and numerous hepatic masses. The imaging findings were consistent with a metastatic disease. The right eye of the patient was enucleated to obtain tissue for diagnosis and for palliative relief.
The diagnosis of uveal melanoma was confirmed through immunohistochemical evaluation.
Uveal melanoma or ocular melanoma is the most common cancer within the eye in adults. In this disease, malignant cells are found in the uvea of the eye that contains cells called melanocytes. The uvea includes the iris and the choroid. When these cells become cancerous, the cancer is called melanoma.
People with uveal melanoma may prevent with no symptoms and the tumour might be detected during routine examination. Symptoms may include decreased or blurry vision and the cancer may grow before it is noticed. Uveal melanoma is relatively rare and involves only 5 to 6 cases per million, each year. Moreover, it usually affects people over 50 years of age.
The patient was treated with nivolumab and ipilimumab for the progressive disease. Unfortunately, the patient died 2 months after presentation.
Sacks, C. A. (2019). Metastatic Uveal Melanoma.