Medical Ophthalmology: Case five

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This 74 year-old man was under the care of the physician. His condition was related to his ocular problem.

a. What is the diagnosis?

Choroidal melanoma with hepatic metastasis.

The picture shows the patient to be jaundice and has a left prosthetic eye. His jaundice is secondary to biliary tract obstruction from hepatic metastasis.
Most metastasis occurs within the first few years after enucleation but some may occur decades after enucleation. The liver is the most common site of involvement.

b. What factors of the primary condition predispose to this condition?

The following factors increase the choroidal melanoma metastasis:

• cell type: epitheloid cell type is associated with high risk of metastasis
• extrascleral extension of the tumour
• large tumour size
• older age group
• increased mitotic activity