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Paraneoplastic vitelliform retinopathy in metastatic cutaneous melanoma
Hatem Krema1, Rand Simpson, Filiberto Altomare
1From the Department of Ocular Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
Purpose:
To report the clinical picture and investigative findings of unusual paraneoplastic retinopathy lesions in a patient with metastatic skin melanoma.
Methods:
A middle-aged man presented with mild blurring of vision in one eye. He had metastatic skin melanoma to the axillary lymph nodes, which was treated by interferon. Fundus photographs showed bilateral unusual multiple vitelliform lesions. Retinal and serologic investigations were performed.
Results:
These vitelliform lesions involved the outer retinal layers and retinal pigment epithelium (RPE) as demonstrated by optical coherence tomography and have completely blocked choroidal fluorescence without late staining in angiography. There was only minimal reduction of Arden ratio in electro-oculography, although electroretinography was essentially normal. Antibipolar cells autoantibodies were not detected in this case.
Conclusion:
This melanoma-related paraneoplastic retinopathy may represent a separate entity from the classic findings in melanoma-associated retinopathy (MAR) syndrome. Optical coherence tomography is helpful to differentiate it from simulating lesions. Recognition of this presentation can help to diagnose the presence of an occult metastaticmelanoma in some cases.
