Posterior capsule opacity as initial manifestation of metastatic cutaneous melanoma

Cutaneous metastatic melanoma usually is locoregional, and represents less than 5% of malignancies known to metastasize to the eye and orbit. When there is intraocular involvement, it most commonly occurs in the choroid, vitreous, and retina.

We report a case of a 71-year-old woman with metastatic melanoma presenting as a pigmented posterior capsular opacity in a pseudophakic eye 14 months after excisional biopsy of an ulcerative cutaneous melanoma of the upper arm.

Histopathology confirmed the presence of melanocytic cells on the surface of the anterior lens optic and the posterior capsular surface, as well as melanophagic invasion of the trabecular meshwork. At 7 months following enucleation, there was no evidence of recurrence by either computed tomography or sequential positron emission tomography.

To our knowledge this is the first report of posterior capsular opacification serving as the initial manifestation of cutaneous metastatic melanoma. With the incidence of cutaneous melanoma on the rise, and an increasing number of cataract procedures performed annually, clinicians should be are of the different ways cutaneous metastatic melanoma may involve the intraocular structures of the eye.