Vitelliform retinopathy in metastatic cutaneous melanoma with choroidal involvement.

Report of a Case. A 73-year-old man was referred for nyctalopia in January 1994. He denied having photopsias. His medical history was significant for metastatic cutaneous melanoma that was in remission. His bestcorrected visual acuity was 20/30 OU. Slitlamp examination results were unremarkable. Funduscopic examination showed multiple neurosensory and retinal pigment epithelial (RPE) detachments of varying size (500-5000 μm) in both eyes (Figure 1). There were layered fluid-lipid interfaces inferiorly in the larger RPE detachments. Fluorescein angiography demonstrated bilateral areas of blocked fluorescence secondary to the fundus lesions, and there was early leakage into the overlying RPE detachment. Echographic examination did not reveal choroidal infiltration. Results of a systemic metastatic workup were negative; however, 16 months later, a magnetic resonance image of the head revealed metastatic lesions involving the parietal lobe. During the next 18 months, his visual acuity remained stable and the neurosensory and RPE detachments resolved. Two years after his initial examination, his visual acuity had deteriorated to 20/70 OU with the presence of atrophy of the RPE and pigmentary changes involving the RPE in the fovea. Despite chemotherapy and radiation, the patient died of metastatic cutaneous melanoma 3 years after the initial diagnosis. His right eye was enucleated after death and was submitted for pathologic examination. Histologically, there was a flat, pigmented, cellular infiltrate within the choroid located just posterior to the equator. The infiltrate was composed of a dense population of spindle-shaped and epithelioid cells with pale cytoplasm and marked nuclear and cellular pleomorphism. Rare mitotic figures were seen in the mass. Large blood vessels coursed throughout the tumor. These findings were consistent with metastatic melanoma involving the choroid. In addition, multiple, small RPE detachments were overlying the tumor (Figure 2).