Late Orbital Recurrence of a Choroidal Melanoma Following Internal Resection: Report of a Case and Review of the Literature

• Published in: Survey of Ophthalmology 2003-03, Vol.48 (2), p.181-190
• Main Authors: Mittica, Nicholas, Vemuganti, Geeta Kashyap, Duffy, Mark, Torczynski, Elise, Edward, Deepak P
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; choroid; Choroid Neoplasms - pathology; Choroid Neoplasms - surgery; endoresection; Female; Humans; internal resection; Magnetic Resonance Imaging; malignant melanoma; Medical sciences; Melanoma - secondary; Melanoma - surgery; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Ophthalmologic Surgical Procedures - methods; Ophthalmology; orbit; Orbit Evisceration; Orbital Neoplasms - secondary; Orbital Neoplasms - surgery; prognosis; radiotherapy; treatment; Tumors and pseudotumors of the eye, orbit, eyelid, lacrimal apparatus
• ISSN: 0039-6257; 1879-3304
• DOI: 10.1016/S0039-6257(02)00458-7

The management of uveal melanomas always has been a challenge to the clinicians and has evolved from the era of eye-removing surgeries to elimination of the tumor by the body's own immune system through vaccines. Evaluating the outcome of each strategy improves our understanding of the disease process and helps us to improvise on the existing modalities of treatment. Internal resection of choroidal melanomas has been described as one of the treatment modalities for this malignant tumor. Tumor recurrences reported following this surgical procedure have been uncommon. We report a rare case of a 61-year-old Caucasian woman who presented with a 2-month history of progressive, painful proptosis in her right eye. Thirteen years ago she underwent internal resection of an intraocular choroidal melanoma in the same eye and had no evidence of metastatic disease. Magnetic resonance imaging demonstrated a mass occupying the superotemporal portion of the right orbit adjacent to the globe and behind the area of prior internal resection. Biopsy of the lesion and the subsequent A right orbital exenteration confirmed the diagnosis of recurrent malignant melanoma. Twenty-four months following exenteration the patient continues to be free of metastatic disease. Since internal surgical resection was described in 1984, this is the latest known recurrence of a posterior choroidal melanoma. In this review, we highlight the clinical features of this rare case and discuss in brief the rationale of various treatment modalities for choroidal melanoma.