Multiple simultaneous choroidal melanomas arising in the same eye: globe salvage by radiotherapy.

Zhang MM, Papakostas TD, Malcolm AW, Ancell KK, Biscotti CV, Gragoudas ES, Daniels AB
Acta Ophthalmol. 2016 94 (8): e799-e802

PMID: 27079925 · DOI:10.1111/aos.13034

PURPOSE - Multiple choroidal melanomas arising in the same eye is a very rare entity, usually leading ophthalmologists to entertain other diagnoses. Historically, the only available treatment reported for this rare entity was enucleation. In this study we demonstrate in a series of patients with multiple simultaneous choroidal melanomas that eye salvage is possible using a variety of radiotherapy techniques.

OBSERVATIONS - Both patients presented with two simultaneous choroidal melanomas in one eye. The first patient was only 30 years old and presented with two largely amelanotic tumours with large exudative retinal detachment. Cytology from fine needle aspiration biopsies from both tumours with immunohistochemistry confirmed two separate melanomas. Sequential radioactive iodine plaque brachytherapy led to regression of both tumours. The second, older patient's two tumours both had the typical appearance of choroidal melanoma and he underwent proton beam irradiation to the entire field leading to tumour regression.

CONCLUSIONS - Multiple choroidal melanomas can rarely arise simultaneously in the same eye, and despite their variable appearance, a definitive diagnosis can be aided by cytology and immunohistochemistry in atypical-appearing cases. While all other previously reported cases have necessitated enucleation, we demonstrate that globe salvage is possible using either proton beam irradiation to the entire tumour field, or with sequential radioactive plaque brachytherapy.

© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

MeSH Terms (13)

Adult Brachytherapy Choroid Neoplasms Female Humans Iodine Radioisotopes Male Melanoma Melanoma, Amelanotic Middle Aged Neoplasms, Multiple Primary Proton Therapy Salvage Therapy

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