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Spectrum of presentation of intraocular metastases from cutaneous melanoma in the era of immunotherapy and targeted therapies

Eye volume 39, pages 1825–1830 (2025)Cite this article

Subjects

Abstract

Background

Intraocular metastases from cutaneous melanoma are rare. Diagnosis can be challenging and there is currently no consensus on treatment. However, with the increasing incidence of this cancer and improved survival of patients treated with targeted BRAF-MEK inhibitors and checkpoint inhibitors, it is likely that more cases will be referred to ocular oncology clinics.

Subjects

Single-centre retrospective study. We included all the patients diagnosed with intraocular metastases from cutaneous melanoma seen between 2017 and 2022.

Results

The first patient had bilateral choroidal metastases and unilateral vitreous cells (treated with external beam radiotherapy and immunotherapy), the second had unilateral amelanotic vitreous metastasis (treated with vitrectomy and BRAF-MEK inhibitors) and the third had bilateral multifocal choroidal metastases (treated with BRAK-MEK inhibitors followed by immunotherapy). The fourth patient (previously reported) had unilateral anterior segment and vitreous metastases (treated with immunotherapy and enucleation). Interestingly, two patients had a history of uveitis in the affected eye, unrelated to the ocular metastases. All four patients had synchronous systemic metastases.

Conclusions

The diagnosis of intraocular metastases from cutaneous melanoma is generally clinical but it is sometimes challenging because of possible masquerade syndromes. The presence of other extraocular metastatic sites is an indicator of the diagnosis. Cytopathologic proof combined with genetic analysis is sometimes necessary for diagnosis, especially with amelanotic vitreous debris or in rare cases where systemic screening is negative. New treatments with targeted BRAF-MEK inhibitors and checkpoint inhibition may avoid external beam radiotherapy and enucleation in some patients.

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Fig. 1: Bilateral macular metastases.
Fig. 2: Amelanotic vitreous metastasis.
Fig. 3: Multiple diffuses bilateral choroidal metastases.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Moorfields Eye Hospital.

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Acknowledgements

The authors would like to thank Lamis Al Harby for her contribution to this work.

Author information

Authors and Affiliations

  1. Service d’oculoplastique, Hôpital ophtalmique Jules-Gonin—Fondation Asile des aveugles, Lausanne, Switzerland

    Stéphanie Lemaître

  2. Moorfields Eye Hospital, London, UK

    Stéphanie Lemaître, Amit K. Arora & Gordon Robert Hay

  3. Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, London, UK

    Mandeep S. Sagoo

Authors
  1. Stéphanie Lemaître
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  2. Amit K. Arora
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  4. Mandeep S. Sagoo
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Contributions

SL—study conception and design, data collection, analysis and interpretation of results, manuscript preparation. AKA—data collection, analysis and interpretation of results. GRH—data collection, analysis and interpretation of results. MSS—study conception and design, analysis and interpretation of results, manuscript preparation.

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Correspondence to Stéphanie Lemaître.

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Lemaître, S., Arora, A.K., Hay, G.R. et al. Spectrum of presentation of intraocular metastases from cutaneous melanoma in the era of immunotherapy and targeted therapies. Eye 39, 1825–1830 (2025). https://doi.org/10.1038/s41433-025-03753-x

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