Metastatic Choroidal Melanoma Treated with Ipilimimab
A 64-year-old man with metastatic cutaneous melanoma developed a decreased vision in his left eye. Visual acuity was 20/25 in the right eye and 20/40 in the left eye (OS). Hematoxylin and eosin stain (10) showed atypical melanocytes present at the dermal-epidermal junction from original cutaneous melanoma (Fig A). Dilated fundus examination of the OS revealed a subretinal pigmented mass surrounding the optic nerve with subretinal fluid (Fig B). Ocular echography revealed a choroidal mass with a thickness of 2.2 mm.

This patient is diagnosedwith metastatic dermal melanoma to the choroid. Continued treatment with ipilimimab, which was begun 3 weeks previously, was recommended. After 4 doses of ipilimimab, the lesion began regressing. Figure C shows the lesion 1 year after ipilimumab. Further regression has continued for 5 years, despite no additional doses of ipilimumab (Fig D). Unfortunately, uveal melanomas have not shown the same favorable response to immunotherapy as cutaneous melanomas.

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