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Ophthalmic Images
February 9, 2017

Regression of Iris Metastasis After Systemic Treatment With Melanoma-Targeted Therapy

Author Affiliations
  • 1Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, Portugal
JAMA Ophthalmol. 2017;135(2):e165462. doi:10.1001/jamaophthalmol.2016.5462

A man in his 40s with a history of cutaneous malignant melanoma on his thigh, treated with complete excision 4 years earlier, presented to the ophthalmology department with sudden onset of blurred vision in his left eye. On biomicroscopy, a suspicious lesion was documented (Figure). A presumed diagnosis of cutaneous melanoma metastasis was suggested by the patient’s history and ultrasound biomicroscopy, revealing a solid lesion with heterogeneous internal reflectivity. Positron emission tomography–computed tomography confirmed metastases affecting the skin, lower limbs, lymph nodes, lungs, and left iris. After multidisciplinary consultation, systemic treatment with a combined regimen of oral BRAF and MEK inhibitors (vemurafenib and cobimetinib) was instituted. Complete regression of the iris lesions was observed after 3 months. The patient is currently receiving oral targeted therapy and close follow-up. New therapeutic strategies, such as MAPK (mitogen-activated protein kinase) pathway inhibitors, have changed the management and improved survival of patients with metastatic melanoma.1

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