K Gündüz1, J A Shields, C L Shields, R C Eagle. 1. Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Abstract
OBJECTIVE: The authors report their experience with cutaneous melanoma metastatic to the vitreous and elaborate on the features of this entity. DESIGN: The study design was a retrospective review. PARTICIPANTS: Three patients with four affected eyes from cutaneous melanoma metastatic to the vitreous participated. INTERVENTION: All three patients were white men, and their mean age was 58 years. The previously excised cutaneous melanomas were all Clark level IV. The mean interval from diagnosis of the primary cutaneous melanoma to vitreous metastasis was 25 months. Ocular findings included clumps of cells arranged in sheets or linear strands on the vitreous framework. The vitreous cells were nonpigmented in two cases and pigmented in one case. Neovascular glaucoma was found in all three cases. After the diagnosis of vitreous melanoma was made by cytopathologic examination, external beam irradiation (5000 cGy) was given in all patients. MAIN OUTCOME MEASURES: Local tumor control and survival were measured. RESULTS: At a mean follow-up of 14 months from diagnosis of vitreous melanoma, tumor control was achieved in only one of the four affected eyes. One eye was enucleated because of painful neovascular glaucoma, and the other two eyes had progressive vitreous disease. After a mean follow-up of 14 months (from ocular diagnosis), all three patients had died. CONCLUSION: Cutaneous melanoma metastatic to the vitreous can present with nonpigmented or pigmented cells. Neovascular glaucoma frequently is found. External beam radiation therapy often is unsuccessful in local tumor control, and systemic prognosis is poor.
OBJECTIVE: The authors report their experience with cutaneous melanoma metastatic to the vitreous and elaborate on the features of this entity. DESIGN: The study design was a retrospective review. PARTICIPANTS: Three patients with four affected eyes from cutaneous melanoma metastatic to the vitreous participated. INTERVENTION: All three patients were white men, and their mean age was 58 years. The previously excised cutaneous melanomas were all Clark level IV. The mean interval from diagnosis of the primary cutaneous melanoma to vitreous metastasis was 25 months. Ocular findings included clumps of cells arranged in sheets or linear strands on the vitreous framework. The vitreous cells were nonpigmented in two cases and pigmented in one case. Neovascular glaucoma was found in all three cases. After the diagnosis of vitreous melanoma was made by cytopathologic examination, external beam irradiation (5000 cGy) was given in all patients. MAIN OUTCOME MEASURES: Local tumor control and survival were measured. RESULTS: At a mean follow-up of 14 months from diagnosis of vitreous melanoma, tumor control was achieved in only one of the four affected eyes. One eye was enucleated because of painful neovascular glaucoma, and the other two eyes had progressive vitreous disease. After a mean follow-up of 14 months (from ocular diagnosis), all three patients had died. CONCLUSION:Cutaneous melanoma metastatic to the vitreous can present with nonpigmented or pigmented cells. Neovascular glaucoma frequently is found. External beam radiation therapy often is unsuccessful in local tumor control, and systemic prognosis is poor.
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