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Updated: Jan 4, 2026
Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography
Published on: December 2, 2022
Intravitreous Cutaneous Metastatic Melanoma in the Era of Checkpoint Inhibition: Unmasking and Masquerading
Jasmine H Francis1, Duncan Berry2, David H Abramson1
1Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical Center, New York, New York.
Purpose:
Cutaneous melanoma metastatic to the vitreous is very rare. This study investigated the clinical findings, treatment, and outcome of patients with metastatic cutaneous melanoma to the vitreous. Most patients received checkpoint inhibition for the treatment of systemic disease, and the significance of this was explored.
Design:
Multicenter, retrospective cohort study.
Participants:
Fourteen eyes of 11 patients with metastatic cutaneous melanoma to the vitreous.
Methods:
Clinical records, including fundus photography and ultrasound results, were reviewed retrospectively, and relevant data were recorded for each patient eye.
Main Outcome Measures:
Clinical features at presentation, ophthalmic and systemic treatments, and outcomes.
Results:
The median age at presentation of ophthalmic disease was 66 years (range, 23-88 years), and the median follow-up from diagnosis of ophthalmic disease was 23 months. Ten of 11 patients were treated with immune checkpoint inhibition at some point in the treatment course. The median time from starting immunotherapy to ocular symptoms was 17 months (range, 4.5-38 months). Half of eyes demonstrated amelanotic vitreous debris. Five eyes demonstrated elevated intraocular pressure, and 4 eyes demonstrated a retinal detachment. Six patients showed metastatic disease in the central nervous system. Ophthalmic treatment included external beam radiation (30-40 Gy) in 6 eyes, intravitreous melphalan (10-20 μg) in 4 eyes, enucleation of 1 eye, and local observation while receiving systemic treatment in 2 eyes. Three eyes received intravitreous bevacizumab for neovascularization. The final Snellen visual acuity ranged from 20/20 to no light perception.
Conclusions:
The differential diagnosis of vitreous debris in the context of metastatic cutaneous melanoma includes intravitreal metastasis, and this seems to be particularly apparent during this era of treatment with checkpoint inhibition. External beam radiation, intravitreous melphalan, and systemic checkpoint inhibition can be used in the treatment of ophthalmic disease. Neovascular glaucoma and retinal detachments may occur, and most eyes show poor visual potential. Approximately one quarter of patients demonstrated ocular disease that preceded central nervous system metastasis. Patients with visual symptoms or vitreous debris in the context of metastatic cutaneous melanoma would benefit from evaluation by an ophthalmic oncologist.
Insights
Metastatic cutaneous melanoma to the vitreous is rare but can occur, especially with immune checkpoint inhibition treatment. Ophthalmic treatments exist, but visual outcomes are often poor, necessitating evaluation by an ophthalmic oncologist.
Area of Science:
- Ophthalmology
- Oncology
- Medical Research
Background:
- Metastatic cutaneous melanoma to the vitreous is an exceptionally rare clinical presentation.
- The advent of immune checkpoint inhibition has potentially altered the landscape of metastatic melanoma, including ocular involvement.
Purpose of the Study:
- To investigate the clinical findings, treatment strategies, and outcomes for patients with metastatic cutaneous melanoma to the vitreous.
- To explore the significance of immune checkpoint inhibition in the context of vitreous metastasis from cutaneous melanoma.
Main Methods:
- A multicenter, retrospective cohort study was conducted.
- Clinical records of 11 patients (14 eyes) with metastatic cutaneous melanoma to the vitreous were reviewed.
- Data collected included clinical features, ophthalmic and systemic treatments, and patient outcomes.
Main Results:
- The median age at presentation was 66 years, with a median follow-up of 23 months.
- Ten of 11 patients received immune checkpoint inhibition, with a median of 17 months from immunotherapy initiation to ocular symptoms.
- Ophthalmic findings included amelanotic vitreous debris, elevated intraocular pressure, and retinal detachment; visual acuity outcomes were varied, with many eyes showing poor visual potential.
Conclusions:
- Vitreous debris in metastatic cutaneous melanoma patients warrants consideration of intravitreal metastasis, particularly during immune checkpoint inhibitor therapy.
- Treatment options include external beam radiation, intravitreous melphalan, and systemic checkpoint inhibition, though neovascular glaucoma and retinal detachments are potential complications.
- Early evaluation by an ophthalmic oncologist is recommended for patients with visual symptoms or vitreous debris in the setting of metastatic cutaneous melanoma.
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