Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension
Purpose: To report the unusual case of a previously stable choroidal nevus, closely followed for over 15 years, which underwent malignant transformation into small choroidal melanoma with massive extrascleral extension. Observations: A 67-year-old Caucasian female was referred to the Stanford Ocular...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993623000051 |
| _version_ | 1797904313432932352 |
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| author | Michael D. Yu Bryce Chiang Malini Veerappan Pasricha Benjamin P. Erickson Prithvi Mruthyunjaya |
| author_facet | Michael D. Yu Bryce Chiang Malini Veerappan Pasricha Benjamin P. Erickson Prithvi Mruthyunjaya |
| author_sort | Michael D. Yu |
| collection | DOAJ |
| description | Purpose: To report the unusual case of a previously stable choroidal nevus, closely followed for over 15 years, which underwent malignant transformation into small choroidal melanoma with massive extrascleral extension. Observations: A 67-year-old Caucasian female was referred to the Stanford Ocular Oncology Service with concern for malignant transformation of a previously stable choroidal nevus in her left eye. Her funduscopic examination demonstrated a dome-shaped choroidal lesion with overlying associated lipofuscin and subretinal fluid, consistent with a diagnosis of small choroidal melanoma. By B-scan ultrasonography, the lesion measured 8.0 × 6.0 mm in base and 2.1 mm in thickness. B-scan ultrasonography also disclosed an associated retroscleral mass, which appeared contiguous with the intraocular melanoma and was confirmed on subsequent orbital magnetic resonance imaging. A decision was made to proceed with enucleation. Under direct endoscopic visualization, the globe and extrascleral mass were fully isolated, mobilized, and removed in toto. At 24 months post-enucleation, the patient remains disease-free without evidence of systemic metastasis or local recurrence. Conclusions/importance: This case describes a small choroidal melanoma hiding massive extrascleral extension, underscoring the value of B-scan ultrasonography. This case also describes the unique management of choroidal melanoma with extrascleral extension using endoscopic enucleation. Performing enucleation under direct endoscopic visualization ensures complete resection and prevents inadvertent transection of the extrascleral component. |
| first_indexed | 2024-04-10T09:46:56Z |
| format | Article |
| id | doaj.art-d2e59745031545bca6bac184ca8c5b1b |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-04-10T09:46:56Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-d2e59745031545bca6bac184ca8c5b1b2023-02-17T04:55:15ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362023-03-0129101797Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extensionMichael D. Yu0Bryce Chiang1Malini Veerappan Pasricha2Benjamin P. Erickson3Prithvi Mruthyunjaya4Ocular Oncology Service, Byers Eye Institute, Stanford University, 2452 Watson Ct, Palo Alto, CA, 94303, USAOcular Oncology Service, Byers Eye Institute, Stanford University, 2452 Watson Ct, Palo Alto, CA, 94303, USAOcular Oncology Service, Byers Eye Institute, Stanford University, 2452 Watson Ct, Palo Alto, CA, 94303, USAOcular Oncology Service, Byers Eye Institute, Stanford University, 2452 Watson Ct, Palo Alto, CA, 94303, USA; Oculoplastic Surgery & Orbital Oncology Service, Byers Eye Institute, Stanford University, 2452 Watson Ct, Palo Alto, CA, 94303, USAOcular Oncology Service, Byers Eye Institute, Stanford University, 2452 Watson Ct, Palo Alto, CA, 94303, USA; Corresponding author.Purpose: To report the unusual case of a previously stable choroidal nevus, closely followed for over 15 years, which underwent malignant transformation into small choroidal melanoma with massive extrascleral extension. Observations: A 67-year-old Caucasian female was referred to the Stanford Ocular Oncology Service with concern for malignant transformation of a previously stable choroidal nevus in her left eye. Her funduscopic examination demonstrated a dome-shaped choroidal lesion with overlying associated lipofuscin and subretinal fluid, consistent with a diagnosis of small choroidal melanoma. By B-scan ultrasonography, the lesion measured 8.0 × 6.0 mm in base and 2.1 mm in thickness. B-scan ultrasonography also disclosed an associated retroscleral mass, which appeared contiguous with the intraocular melanoma and was confirmed on subsequent orbital magnetic resonance imaging. A decision was made to proceed with enucleation. Under direct endoscopic visualization, the globe and extrascleral mass were fully isolated, mobilized, and removed in toto. At 24 months post-enucleation, the patient remains disease-free without evidence of systemic metastasis or local recurrence. Conclusions/importance: This case describes a small choroidal melanoma hiding massive extrascleral extension, underscoring the value of B-scan ultrasonography. This case also describes the unique management of choroidal melanoma with extrascleral extension using endoscopic enucleation. Performing enucleation under direct endoscopic visualization ensures complete resection and prevents inadvertent transection of the extrascleral component.http://www.sciencedirect.com/science/article/pii/S2451993623000051ChoroidMelanomaExtraocular extensionMetastasis |
| spellingShingle | Michael D. Yu Bryce Chiang Malini Veerappan Pasricha Benjamin P. Erickson Prithvi Mruthyunjaya Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension American Journal of Ophthalmology Case Reports Choroid Melanoma Extraocular extension Metastasis |
| title | Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension |
| title_full | Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension |
| title_fullStr | Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension |
| title_full_unstemmed | Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension |
| title_short | Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension |
| title_sort | endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension |
| topic | Choroid Melanoma Extraocular extension Metastasis |
| url | http://www.sciencedirect.com/science/article/pii/S2451993623000051 |
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