Supplementary Material for: Metastatic Cutaneous Melanoma Presenting with Choroidal Metastasis Mimicking Lymphoma: A Case Report

Introduction: Approximately 5% of patients with cutaneous melanoma develop distant metastases, and very rarely, can involve the eye and orbit. This case report discusses a patient with an unusual presentation of choroidal metastasis secondary to cutaneous melanoma.
Case presentation: A 76-year-old man with a past medical history of cutaneous melanoma on the right shoulder status post radiation presented to the ocular oncology clinic with a three-month history of decreased vision, occasional pain, and floaters in the right eye. Initial examination revealed a visual acuity of hand motion in the right eye, intraocular pressure of 5 mmHg, and no view to the fundus due to vitreous hemorrhage. B-scan did not show a retinal tear, retinal detachment, or intraocular tumor. The patient underwent pars plana vitrectomy of the right eye where massive choroidal thickening with subretinal yellow deposits obstructing the optic nerve head was seen, initially concerning lymphoma. At postoperative week one, visual acuity remained hand motion and the fundus exam showed clear vitreous and retinal/choroidal infiltrates obscuring the optic nerve and macula. Repeat B-scan showed retinal and choroidal thickening with exudates. Cytology results from surgery later revealed malignant cells consistent with melanoma. The patient underwent ocular radiation but eventually progressed to no light perception visual acuity. He is currently under observation with the goal of palliative care.
Conclusion: This case highlights the importance of maintaining a high level of suspicion for metastasis in the setting of melanoma history even when presentation can be atypical. Early recognition of choroidal metastasis allows for timely intervention, improving the chances of preserving vision.

引言：约5%的皮肤黑色素瘤（cutaneous melanoma）患者会发生远处转移，其中累及眼及眼眶的情况极为罕见。本病例报告探讨了1例继发于皮肤黑色素瘤的脉络膜转移瘤（choroidal metastasis）表现不典型的患者。
病例报告：1例76岁男性患者，既往有右肩部皮肤黑色素瘤病史且曾接受放射治疗，因右眼视力下降、偶发眼痛及飞蚊症（floaters）3个月就诊于眼肿瘤门诊。初始检查显示右眼视力为手动，眼压（intraocular pressure）为5 mmHg，因玻璃体积血无法窥清眼底。B型超声扫描（B-scan）未发现视网膜裂孔、视网膜脱离或眼内肿瘤。患者接受了经睫状体平坦部玻璃体切割术（pars plana vitrectomy），术中可见大范围脉络膜增厚，伴视网膜下黄色沉积物阻塞视神经乳头，最初怀疑为淋巴瘤（lymphoma）。术后1周，右眼视力仍为手动，眼底检查可见玻璃体清亮，但视网膜/脉络膜浸润灶遮挡了视神经及黄斑（macula）。复查B型超声扫描显示视网膜及脉络膜增厚伴渗出物（exudates）。术中获取的细胞学检查结果显示恶性细胞符合黑色素瘤表现。患者随后接受了眼部放疗，但最终视力进展为无光感。目前患者处于观察阶段，治疗目标为姑息治疗（palliative care）。
结论：本病例表明，即便临床表现不典型，对于有黑色素瘤病史的患者，仍需高度警惕远处转移的可能。早期识别脉络膜转移瘤可实现及时干预，从而提高保留视力的概率。