Bilateral ocular manifestations of aggressive cutaneous metastatic melanoma

To report an unusual case of aggressive cutaneous malignant melanoma metastatic to both eyes. The case is also remarkable for differences from the bilateral diffuse uveal melanocytic proliferation syndrome (BDUMP).

Observational case report.

The authors studied the case of a 56-year-old man with decreased vision and floaters in the left eye. He recently had been diagnosed with metastatic cutaneous malignant melanoma.

Clinical examination, fundus photography, and ultrasonography revealed widespread metastases to the choroid, ciliary body, iris, and eyelid. A-scan revealed medium internal reflectivity of a collar-button lesion in the ciliary body, consistent with metastatic disease.

Despite the rarity of BDUMP and bilateral intraocular malignant cutaneous or uveal melanoma metastases, these diagnoses should be considered when diffuse bilateral melanocytic lesions are present. Ultrasonography and metastatic workup are critically important to help distinguish these disease entities.