Abstract
Background
Intraocular metastases from cutaneous melanoma are rare. Diagnosis can be challenging and there is currently no consensus on treatment. However, with the increasing incidence of this cancer and improved survival of patients treated with targeted BRAF-MEK inhibitors and checkpoint inhibitors, it is likely that more cases will be referred to ocular oncology clinics.
Subjects
Single-centre retrospective study. We included all the patients diagnosed with intraocular metastases from cutaneous melanoma seen between 2017 and 2022.
Results
The first patient had bilateral choroidal metastases and unilateral vitreous cells (treated with external beam radiotherapy and immunotherapy), the second had unilateral amelanotic vitreous metastasis (treated with vitrectomy and BRAF-MEK inhibitors) and the third had bilateral multifocal choroidal metastases (treated with BRAK-MEK inhibitors followed by immunotherapy). The fourth patient (previously reported) had unilateral anterior segment and vitreous metastases (treated with immunotherapy and enucleation). Interestingly, two patients had a history of uveitis in the affected eye, unrelated to the ocular metastases. All four patients had synchronous systemic metastases.
Conclusions
The diagnosis of intraocular metastases from cutaneous melanoma is generally clinical but it is sometimes challenging because of possible masquerade syndromes. The presence of other extraocular metastatic sites is an indicator of the diagnosis. Cytopathologic proof combined with genetic analysis is sometimes necessary for diagnosis, especially with amelanotic vitreous debris or in rare cases where systemic screening is negative. New treatments with targeted BRAF-MEK inhibitors and checkpoint inhibition may avoid external beam radiotherapy and enucleation in some patients.
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Fig. 1: Bilateral macular metastases.
Fig. 2: Amelanotic vitreous metastasis.
Fig. 3: Multiple diffuses bilateral choroidal metastases.
Data availability
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Moorfields Eye Hospital.
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Acknowledgements
The authors would like to thank Lamis Al Harby for her contribution to this work.
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Authors and Affiliations
Service d’oculoplastique, Hôpital ophtalmique Jules-Gonin—Fondation Asile des aveugles, Lausanne, Switzerland
Stéphanie Lemaître
Moorfields Eye Hospital, London, UK
Stéphanie Lemaître, Amit K. Arora & Gordon Robert Hay
Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, London, UK
Mandeep S. Sagoo
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Stéphanie Lemaître
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2. Amit K. Arora
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Contributions
SL—study conception and design, data collection, analysis and interpretation of results, manuscript preparation. AKA—data collection, analysis and interpretation of results. GRH—data collection, analysis and interpretation of results. MSS—study conception and design, analysis and interpretation of results, manuscript preparation.
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Correspondence to Stéphanie Lemaître.
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Lemaître, S., Arora, A.K., Hay, G.R. et al. Spectrum of presentation of intraocular metastases from cutaneous melanoma in the era of immunotherapy and targeted therapies. Eye (2025). https://doi.org/10.1038/s41433-025-03753-x
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Received:10 December 2023
Revised:29 October 2024
Accepted:03 March 2025
Published:25 March 2025
DOI:https://doi.org/10.1038/s41433-025-03753-x
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