Abstract ID: 26-256
Neglected Necrotic Malignant Melanoma Arising from Choroidal Nevus During 14 Years of Irregular Follow-up: A Case Presenting as Orbital Cellulitis
Author: Beyza Yalçın Base Hospital / Institution: Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
Presentation Type: ePoster Presentation
Purpose
To present a rare case of necrotic malignant melanoma arising from a previously observed choroidal nevus and presenting as orbital cellulitis.
Methods
Retrospective case report.
Results
A 69-year-old woman presented with decreased vision, pain, redness, and ophthalmoplegia in the right eye. Visual acuity was limited to light perception. Examination disclosed restriction of ocular motility in all directions, ptosis, conjunctival hyperemia and chemosis, iris neovascularization, pupillary distortion, and mature cataract. Intraocular pressure was 34 mmHg. Fundus examination was not possible; ultrasonography demonstrated a nearly cavity-filling hyperechoic mass. Review of prior records revealed follow-up for a right choroidal nevus since 2012. In 2020, the lesion had enlarged to 6×6 mm in basal diameter and 7 mm in thickness, with subretinal fluid on optical coherence tomography. Plaque brachytherapy was recommended, but the patient declined treatment. Orbital magnetic resonance imaging showed preseptal and postseptal enhancement, T1-hyperintense vitreous content, and perineural enhancement of the right optic nerve extending to the prechiasmatic level. Myoconjunctival enucleation was performed. Histopathology disclosed a completely necrotic malignant melanoma with scleral invasion. Tumor dimensions were 17 mm in basal diameter and 14 mm in thickness; the tumor was staged as pT4a and showed optic nerve involvement beyond the lamina cribrosa.
Conclusion
This case illustrates that a lesion initially monitored as a choroidal nevus may progress to necrotic malignant melanoma and present as orbital cellulitis when left untreated. Necrotic malignant melanoma should be considered in the differential diagnosis of orbital cellulitis, particularly in patients with a history of an underlying melanotic lesion.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Mehmet Serhat | Mangan | Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye |
| Begüm | Yeni Erdem | Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye |
| Şule | Öztürk Sarı | Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye |