Eyelids metastases from uveal melanoma: clinical and histopathologic features of two cases and literature review

Abstract

Purpose: To report the clinical and histopathologic features of two cases of eyelids metastases from uveal melanoma diagnosed in a metachronous and synchronous fashion.

Methods: Monocentric retrospective case series of histopathologically proven eyelids metastases from uveal melanoma at our institution.

Results: Two patients were presented to our hospital for upper eyelids pigmented and firm lesions. Patient 1 had an history of left uveal melanoma treated conservatively with proton beam therapy 5 years earlier. Examination revealed bilateral upper eyelids lesions. Patient 2 had no malignancy history but was incidentally diagnosed with a cerebral nodule few months earlier. Examination revealed a right upper eyelid nodule and a previously unknown right uveal melanoma. Excisional biopsy was performed for both patients. Pathological assessment allowed the presence of melanoma cells. The lack of BAP1 nuclear expression on immunohistochemistry as well as the absence of cutaneous or mucosal melanoma were consistent with an uveal origin. Diffuse metastatic spread was noted for both patients. Systemic therapies were prescribed. Patient 1 died from metastatic spread (62 months and 4 months after uveal melanoma diagnosis and eyelids metastases removal, respectively) whereas patient 2 was still alive (14 months follow up).

Conclusions: Eyelids metastases from uveal melanoma is an exceptional finding. Excisional biopsy and pathological assessment are of main importance to confirm the diagnosis and to identify genetic mutations for further targeted therapies. Currently, prognosis remains poor.

Fig. 1

a Left fundus photography demonstrating a large pigmented choroidal mass of the posterior pole with orange pigment over its surface and serous retinal detachment located between the optic nerve and macula. b High field retinophotography demonstrating an intra-choroidal metastasis inferonasal to the previously treated choroidal melanoma. c More than ten black subcutaneous metastases are noted on the patient’s face. d Eyes closed. Note the bilateral subcutaneous upper eyelids metastases. e The eyelid and the tarsal plate were infiltrated by a mixed population of spindle and small epithelioid cells with moderate nuclear pleomorphism. Magnification 126 × ; stain: hematoxylin-eosin. f By immunohistochemistry, there was a loss of nuclear expression of BAP1 (red arrows)Magnification: 126 ×

Fig. 2

a Fundus photography demonstrating a right melanoma of the posterior pole. b Pigmented external upper eyelid nodule measuring 7 × 7 mm without ptosis or madarosis. c Pathological findings: the dermis is filled with sheets of large and atypical epithelioid cells. Scattered pigmented melanophages can also be observed. Magnification 126 × ; stain: hematoxylin-eosin. d There was a loss of BAP1 nuclear expression by immunohistochemistry (white arrows). Positive nuclear expression can be observed in the overlaying epidermis (black arrows) Magnification: 126 ×