CUTANEOUS MELANOMA METASTATIC TO THE VITREOUS CAVITY

Objective: The authors report their experience with cutaneous melanoma metastatic to the vitreous and elaborate on the features of this enti ty. Design: The study design was a retrospective review. Participants: Three patients with four affected eyes from cutaneous melanoma metast atic to the vitreous participated. Intervention: All three patients we re white men, and their mean age was 58 years. The previously excised cutaneous melanomas were all Clark level IV. The mean interval from di agnosis of the primary cutaneous melanoma to vitreous metastasis was 2 5 months. Ocular findings included clumps of cells arranged in sheets or linear strands on the vitreous framework. The vitreous cells were n onpigmented in two cases and pigmented in one case. Neovascular glauco ma was found in all three cases, After the diagnosis of vitreous melan oma was made by cytopathologic examination, external beam irradiation (5000 cGy) was given in all patients. Main Outcome Measures: Local tum or control and survival were measured. Results: At a mean follow-up of 14 months from diagnosis of vitreous melanoma, tumor control was achi eved in only one of the four affected eyes. One eye was enucleated bec ause of painful neovascular glaucoma, and the other two eyes had progr essive vitreous disease. After a mean follow-up of 14 months (from ocu lar diagnosis), all three patients had died. Conclusion: Cutaneous mel anoma metastatic to the vitreous can present with nonpigmented or pigm ented cells, Neovascular glaucoma frequently is found, External beam r adiation therapy often is unsuccessful in local tumor control, and sys temic prognosis is poor.