Metastatic Cutaneous Melanoma Presenting with Choroidal Metastasis Mimicking Lymphoma: A Case Report.

Introduction: Approximately 5% of patients with cutaneous melanoma develop distant metastases, and very rarely, can involve the eye and orbit. This case report discusses a patient with an unusual presentation of choroidal metastasis secondary to cutaneous melanoma.

Case presentation: A 76-year-old man with a past medical history of cutaneous melanoma on the right shoulder status post radiation presented to the ocular oncology clinic with a 3-month history of decreased vision, occasional pain, and floaters in the right eye. Initial examination revealed a visual acuity of hand motion in the right eye, intraocular pressure of 5 mm Hg, and no view to the fundus due to vitreous hemorrhage. B-scan did not show a retinal tear, retinal detachment, or intraocular tumor. The patient underwent pars plana vitrectomy of the right eye where massive choroidal thickening with subretinal yellow deposits obstructing the optic nerve head was seen, initially concerning lymphoma. On postoperative week one, visual acuity remained hand motion and the fundus exam showed clear vitreous and retinal/choroidal infiltrates obscuring the optic nerve and macula. Repeat B-scan showed retinal and choroidal thickening with exudates. Cytology results from surgery later revealed malignant cells consistent with melanoma. The patient underwent ocular radiation but eventually progressed to no light perception visual acuity. He is currently under observation with the goal of palliative care.

Conclusion: This case highlights the importance of maintaining a high level of suspicion for metastasis in the setting of melanoma history even when presentation can be atypical. Early recognition of choroidal metastasis allows for timely intervention, improving the chances of preserving vision.