Choroidal melanoma presenting with anterior segment involvement and phthisis bulbi.

To cite: Holla A, Gonsalves SRJ. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013200793 DESCRIPTION A 70-year-old woman presented with a painless fleshy mass in the right eye of 3 months duration with no history of trauma. She gave a history of cataract surgery in the same eye 4 years ago. Examination revealed an irregular, black, fleshy, lobulated mass with vascularisation extending medially up to the inner canthus (figure 1). The superior extent could not be made out. The systemic examination was unremarkable. B-scan ultrasonography showed a large domeshaped mass with acoustic hollowness, orbital shadowing with phthisis bulbi. CT orbit showed a decrease in the size of the right eye, soft tissue density in the globe measuring 1.2×1 cm with calcification (figure 2). MRI orbit—T1 hyperintense and T2 hypointense lesion arising in the posterior segment, extending anteriorly in the right eyeball (figure 3A, B). Enucleation was performed (figure 4), histopathology confirmed spindle cell variety of choroidal melanoma with occasional mitotic activity in the phthisical eye. The optic nerve was free (figure 5). Metastasis workup in the form of chest X-ray, ultrasonography of the abdomen, serum lactate dehydrogenase and liver function tests were normal. The patient was referred to the department of radiation oncology for chemotherapy. Though choroidal melanoma is the commonest primary intraocular malignancy, it has a very low incidence in Asians. In most cases, age at diagnosis is about 55 years, and there is preponderance in men ; unlike our patient, who was an elderly woman.