Dissemination of Uveal Melanoma After Diagnostic Biopsy With 23-Gauge Vitrector.

Abstract

Purpose: To report a case with tumor dissemination after diagnostic choroidal biopsy.

Methods: Multimodal imaging and histopathology correlation.

Results: A 64-year-old male presented with an atypical uveal mass and underwent a diagnostic transretinal 23-gauge vitrector biopsy to diagnose melanoma. Post-operative course was complicated by prolonged vitreous hemorrhage which required vitrectomy, delaying proton beam treatment by two months. One year after the biopsy, the tumor cells had disseminated to the retina, optic nerve, iris, iridocorneal angle, and extraocularly via the vitrectomy port. The patient died from metastatic melanoma one year later. To the best of our knowledge, there are 10 prior cases with biopsy-related tumor seeding in the literature, with risk features including multiple vitreous surgeries, a long interval between biopsy and treatment, and high-risk melanoma cytogenetics. Severe vitreous hemorrhage following biopsy further postpone treatments or warrant vitrectomy, both increasing the risk of tumor spread.

Conclusions: Biopsy of choroidal melanoma, especially when complicated by severe vitreous hemorrhage, can lead to dissemination of the malignant tumor.