Spontaneous regression of choroidal metastasis from renal cell carcinoma.

Purpose: To report a case of an elderly man who presented with a choroidal metastasis from renal cell carcinoma that spontaneously regressed prior to any local or systemic treatment. Observations: An 82-year-old man without a history of metastatic cancer was referred to the ocular oncology service for evaluation of a newly noted amelanotic choroidal lesion. Examination and imaging findings were concerning for choroidal metastasis. Systemic workup revealed previously undiagnosed widely metastatic renal cell carcinoma. The lesion spontaneously regressed prior to the initiation of any treatment for his tumor. Conclusions and importance: This is a unique case of choroidal metastases from renal cell carcinoma that spontaneously regressed prior to medical or surgical treatment of the primary tumor.

Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy.

Brain metastases commonly develop in melanoma and are associated with poor overall survival of about five to nine months. Fortunately, new therapies, including immune checkpoint inhibitors and BRAF/MEK inhibitors, have been developed. The aim of this study was to identify outcomes of different treatment strategies in patients with melanoma brain metastases in the era of checkpoint inhibitors. Patients with brain metastases secondary to melanoma were identified at a single institution. Univariate and multivariable analyses were performed to identify baseline and treatment factors, which correlated with progression-free and overall survival. A total of 209 patients with melanoma brain metastases were identified. The median overall survival of the cohort was 5.3 months. On multivariable analysis, the presence of non-cranial metastatic disease, poor performance status (ECOG 2-4), whole-brain radiation therapy, and older age at diagnosis of brain metastasis were associated with poorer overall survival. Craniotomy (HR 0.66, 95% CI 0.45-0.97) and treatment with a CTLA-4 checkpoint inhibitor (HR 0.55, 95% CI 0.32-0.94) were the only interventions associated with improved overall survival. Further studies with novel agents are needed to extend lifespan in patients with brain metastases in melanoma.

Presumed Melanoma of Unknown Primary Origin Metastatic to the Choroid Mimics Primary Uveal Melanoma.

We describe the case of a 69-year-old woman who presented with a decline in vision in the left eye and was found to have a choroidal lesion with clinical and echographic features concerning for primary uveal melanoma. Systemic imaging identified numerous metastases to the liver, kidneys, paratracheal lymph nodes, lung, and brain. The hepatic lesion was biopsied, and genetic analysis identified a Val600Glu (c.1799T>A) BRAF mutation, consistent with a cutaneous primary malignancy, although no primary tumor was identified. This case highlights that metastasis to the choroid is a rare presentation of nonuveal melanoma that can mimic primary uveal melanoma. Genetic analysis of tumor tissue can identify the origin of the melanoma and guide treatment options. Systemic imaging should be performed prior to intervention for choroidal neoplasms.