Orbital Recurrence of Malignant Melanoma Following Needle Biopsy: Case Report and Literature Review

Abstract

Purpose: : A patient evaluated for potential ocular tumor was biopsied, diagnosed with choroidal melanoma and later developed disease recurrence. A literature review uncovered at least 15 other cases. Case Report: A 63 year-old man with blurry vision in the left eye was evaluated. The right eye was normal. The left eye had light perception, an afferent pupillary defect and a total retinal detachment with fluid and solid subretinal components. MRI showed a mass within the globe. The diagnosis was retinal detachment with blood and possible tumor. The patient had a transvitreal aspiration biopsy of the mass with a 27 gauge needle. It was negative for malignant melanoma. The subretinal hemorrhage remained unresolved so the fluid was drained. Pathology of the fluid showed benign cells and degenerated blood. Biopsy of the remaining mass showed spindle B choroidal melanoma. The eye was enucleated and diagnosis confirmed. Melanoma cells were noted along the needle track. Three years later the patient complained of a dislodging prosthesis. Pigmented lesions were seen on the conjunctiva. MRI showed a mass at the eyelid. Biopsy of the mass showed melanoma. The mass was resected and the patient radiated. Despite resolution of the mass, the patient developed widespread disease.

Methods: : A literature search for all documented cases of orbital recurrence following intraocular tumor biopsy.

Results: : At least 15 cases of orbital recurrence of malignant melanoma following tumor biopsy have been documented. Biopsy methods were described as: excisional, incisional with 2-5 mm length, diathermy with subretinal fluid removal, and fine-needle aspiration biopsy. Instruments ranged from "fine-caliber hypodermic needle" to 25 gauge needle. Tumor extension was reported as early as 13 days and as late as 6 years following biopsy. At least 5 cases reported patient death from metastasis during follow-up.

Conclusions: : Review of the literature indicates that this complication has been known since the procedure's inception in the 1950's. Although smaller needles and transvitreal approaches may minimize this devastating complication, clinicians should be aware that this rare complication continues to be a risk of invasive diagnostic procedures.

Keywords: melanoma • choroid • orbit