Very late local recurrence of uveal melanoma following successful trans-scleral local resection

Abstract

A 39-year old Caucasian man underwent extensive trans-scleral iridocyclochoroidectomy (without adjuvant plaque brachytherapy or proton beam therapy) for a large choroidal and ciliary body melanoma in 1989. The resected tumour was of spindle cell type and measured 12 × 12 × 10 mm (basal dimensions, height). The patient underwent clinical surveillance for recurrence. Twenty-six years later, in 2015, the patient developed tumour recurrence which was confirmed both clinically and with B-scan ultrasonography, which demonstrated a 9.2 × 8.4 × 4.0 mm solid elevated dome-shaped lesion, with a collar-stud appearance, considered to be characteristic of a choroidal melanoma. Given that the patient was radiation-naïve, this recurrence was treated with ruthenium-106 plaque brachytherapy. Reduction in tumour size was confirmed at follow-up four months post-brachytherapy (tumour height = 1.3 mm), and maintained to the most recent follow-up in March 2019.Very late recurrence of uveal melanoma may occur following trans-scleral local resection. This case highlights the need for life-long clinical surveillance to detect delayed local recurrence, especially given that local recurrence imparts a significantly increased risk of metastatic disease.

Keywords

• Uveal melanoma
• Choroidal melanoma
• Recurrence
• Late
• Longterm
• Resection