Case Report/Case Series
September 2013

Extraocular Extension of Uveal Melanoma After Fine-Needle Aspiration, Vitrectomy, and Open Biopsy

Author Affiliations
  • 1Retina Consultants of Houston, Houston, Texas
  • 2Dartmouth Medical School, Hanover, New Hampshire
  • 3Memorial Sloan-Kettering Cancer Center, New York, New York
  • 4Wills Eye Institute, Philadelphia, Pennsylvania
  • 5Fundación Oftalmológica Argentina Jorge Malbran, Buenos Aires, Argentina

Copyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Ophthalmol. 2013;131(9):1220-1224. doi:10.1001/jamaophthalmol.2013.2506

Importance  The most potentially devastating complication of fine-needle aspiration biopsy (FNAB) or open biopsy is extraocular extension of the tumor. In this collaborative case series, we report 4 cases of orbital recurrence of malignant melanoma as a late complication of biopsy and/or vitrectomy performed at referring institutions and then sent to us for evaluation.

Observations  Four cases of extraocular extension of melanoma are documented following multiple procedures including FNAB, vitrectomy, and open biopsies. Three of the patients in this series underwent more than 1 FNAB, biopsy, and/or vitrectomy. One underwent FNAB only but did not undergo brachytherapy afterward. Most of the FNABs, open biopsies, and vitrectomies reported in these cases were not performed by us, so details of the technique are not available. From these cases, we are not able to determine whether the FNAB or additional invasive procedures caused the subsequent extraocular disease or if growth of the tumor into the extraocular space occurred independent of or prior to the procedures.

Conclusions and Relevance  Large series of FNAB for uveal melanoma with no extraocular recurrence have been reported by multiple experienced centers, and the vast majority of these procedures are performed without effect on the patient’s prognosis. However, the patients described in this series demonstrate that this complication is rarely possible.