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Metastatic Cutaneous Melanoma to the Choroid
A 68-year-old woman presented with blurry vision in the left eye, a condition that she had noticed for three weeks. Three years prior, she had undergone wide excision of cutaneous melanoma 13 mm in depth on her left forearm. At that time, 10 left axillary sentinel lymph nodes were biopsied and were found to be negative.
On ocular examination, her visual acuity was 20/20 in the right eye and 20/70 in the left eye. A dilated fundus exam of her left eye revealed a pigmented choroidal mass along the superotemporal arcade, with orange pigment and subretinal fluid extending into the fovea. The mass measured 3.2 mm in apical height with a basal diameter of 9.0 mm x 10.6 mm by ultrasonography. The A-scan demonstrated high internal reflectivity.
Given the patient’s history of cutaneous melanoma, a PET scan was performed, which revealed multiple lesions in the lungs and a 4-cm lesion in the liver consistent with metastatic disease. The choroidal lesion was presumed to be metastatic in nature and the patient was referred to oncology. A lung biopsy was performed, which confirmed metastatic melanoma.
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