Extraocular Extension of a Regressed Choroidal Melanoma after Vitrectomy and Scleral Buckle for Rhegmatogenous Retinal Detachment

A 53-year-old man with a history of choroidal melanoma (Fig A-B) treated with brachytherapy presented 18 months post-plaque with a giant retinal tear and rhegmatogenous retinal detachment. The melanoma had shown regression at prior visits, and ultrasound confirmed a decrease in thickness from 5.7 to 4.7 mm (Fig C). Because the melanoma appeared regressed, he was treated with vitrectomy/silicone oil placement and scleral buckle. Seven months later, his condition was stable and the retina was attached. One year later he returned with eye pain, intraocular pressure of 51, and 3 conjunctival masses indicating melanoma (Fig D). The eye was enucleated, and pathology confirmed enlargement of the melanoma with extension of the tumor into the ciliary body, displacing the iris anteriorly and forming a nodule overlying the sclera (Magnified version of Fig A-D is available online at www.aaojournal.org).