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Case Report/Case Series |

Extraocular Extension of Uveal Melanoma After Fine-Needle Aspiration, Vitrectomy, and Open Biopsy

Amy C. Schefler, MD1; Daniel Gologorsky, BA2; Brian P. Marr, MD3; Carol L. Shields, MD4; Ignacio Zeolite, MD5; David H. Abramson, MD3
[+] Author Affiliations
1Retina Consultants of Houston, Houston, Texas
2Dartmouth Medical School, Hanover, New Hampshire
3Memorial Sloan-Kettering Cancer Center, New York, New York
4Wills Eye Institute, Philadelphia, Pennsylvania
5Fundación Oftalmológica Argentina Jorge Malbran, Buenos Aires, Argentina
JAMA Ophthalmol. 2013;131(9):1220-1224. doi:10.1001/jamaophthalmol.2013.2506.
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Published online

Importance  The most potentially devastating complication of fine-needle aspiration biopsy (FNAB) or open biopsy is extraocular extension of the tumor. In this collaborative case series, we report 4 cases of orbital recurrence of malignant melanoma as a late complication of biopsy and/or vitrectomy performed at referring institutions and then sent to us for evaluation.

Observations  Four cases of extraocular extension of melanoma are documented following multiple procedures including FNAB, vitrectomy, and open biopsies. Three of the patients in this series underwent more than 1 FNAB, biopsy, and/or vitrectomy. One underwent FNAB only but did not undergo brachytherapy afterward. Most of the FNABs, open biopsies, and vitrectomies reported in these cases were not performed by us, so details of the technique are not available. From these cases, we are not able to determine whether the FNAB or additional invasive procedures caused the subsequent extraocular disease or if growth of the tumor into the extraocular space occurred independent of or prior to the procedures.

Conclusions and Relevance  Large series of FNAB for uveal melanoma with no extraocular recurrence have been reported by multiple experienced centers, and the vast majority of these procedures are performed without effect on the patient’s prognosis. However, the patients described in this series demonstrate that this complication is rarely possible.

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Figures

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Figure 1.
B-Scan Ultrasonography

B-scan ultrasonography shows a solid subretinal component inferonasally in the left eye extending anteriorly up to the lens.

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Figure 2.
Histopathology of the Enucleation Specimen and Choroidal Melanoma

A, Histopathology of the enucleation specimen demonstrates a mixed spindle B epithelioid malignant melanoma of the choroid (hematoxylin-eosin, original magnification ×25). B, Histopathology of choroidal melanoma demonstrates extraocular extension with full scleral involvement (hematoxylin-eosin, original magnification ×100).

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Figure 3.
Histopathology of the Orbital Specimen

Histopathology of the orbital specimen demonstrates choroidal melanoma with infiltrating islands within the orbital fat (hematoxylin-eosin, original magnification ×25).

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Figure 4.
Fundus Photograph of the Left Eye

Fundus photograph of the left eye demonstrates optic disc pallor and retinal pigment epithelial hyperplasia with subretinal fibrosis.

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Figure 5.
Left Globe

High-magnification gross photograph of the left globe demonstrates hyperpigmented cells scattered throughout the vitreous cavity with apparent extraocular extension. Note amelanotic tumor extension near the pars plicata, which was confirmed on histopathology slides cut through this area.

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Figure 6.
Inferior Forniceal Mass

Inferior forniceal mass in the right eye. Histopathology demonstrated uveal melanoma.

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Figure 7.
T1-Weighted Magnetic Resonance Image

T1-weighted magnetic resonance image demonstrates orbital recurrence of uveal melanoma.

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Figure 8.
Subconjunctival Melanotic Infiltrates

Multifocal areas of subconjunctival melanotic infiltrates after transscleral biopsy.

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