Delayed presentation of a metastatic choroidal melanoma to the liver: The latency of an elective metastatic localization

• Biologically, cutaneous and ocular melanoma may be considered different, in terms of both metastatic diffusion and metastatic latency.
• The principal target organ for metastasis of the ocular melanoma is the liver.
• This distinctive behaviour is also sustained by a different metastatic latency to the liver.
• In ocular melanoma synchronous disease accounts for less than 1% of the cases, the majority of patients will develop liver metastasis during the subsequent follow-up period and some of these will present with metastatic ocular melanoma to the liver several years after the treatment of the primary tumor.

IntroductionChoroidal melanoma is the most common primary intraocular malignant tumour and the second most common type of primary malignant melanoma in the body. Biologically, cutaneuous and ocular melanoma may be considered different, in terms of both metastatic diffusion and metastatic latency. The principal target organ for metastasis of the ocular melanoma is the liver.This distinctive behaviour is also sustained by different metastatic latency, as some patients present with metastatic ocular melanoma several years after the treatment of the primary tumor.Presentation of caseA 60 year-old male who had undergone left ocular enucleation for choroid melanoma 20 years ago was referred to our department with a three months history of diffuse abdominal pain, fever, weight loss and massive ascites. Abdominal ultrasonography (US) and total body computed tomography (CT) scan were performed and revealed diffuse liver metastases, associated with peritoneal carcinosis, bilateral adrenal metastases and a large mass in the left kidney compatible with another secondary localization. An ultrasound guided fine needle agobiopsy (FNA) of liver lesions was performed and the pathological findings led to the diagnosis of liver metastasis from choroidal melanoma. The patient died a few weeks later for hepatic failure.DiscussionCurrently, there is no consensus regarding the optimal follow-up in terms of screening modality or time interval after the treatment of the primary ocular melanoma.ConclusionPatients with gastrointestinal symptoms and a history of choroidal melanoma should be investigated for the presence of gastrointestinal or liver metastases, although the original primary malignancy was diagnosed years before the patient’s presentation.