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Case Reports
. 2022 Jun;8(2):105-109.
doi: 10.1159/000524052. Epub 2022 Mar 28.

Intraocular Lens and Lens Capsule Spread of Iridociliary Melanoma: Clinical and Histopathologic Features of 2 Cases

Corrina P Azarcon  1 , Jill R Wells  1 , Thomas Aaberg  2 , Hans E Grossniklaus  1
Affiliations
Case Reports

Intraocular Lens and Lens Capsule Spread of Iridociliary Melanoma: Clinical and Histopathologic Features of 2 Cases

Corrina P Azarcon et al. Ocul Oncol Pathol. 2022 Jun.

Abstract

Purpose: The aim of this study was to describe 2 patients with intraocular lens (IOL) and lens capsule spread of iridociliary melanoma.

Methods: Two pseudophakic patients with iridociliary body melanoma that spread onto the surface of their IOL and remaining lens capsule were included. Their eyes were enucleated and the histopathologic features were evaluated.

Results: Case 1 was an 82-year-old woman with diffuse primary iridociliary melanoma affecting the iris, lens capsule, IOL surface, and ciliary body. Case 2 was a 68-year-old female who developed melanoma recurrence in the anterior segment after plaque brachytherapy for iridociliary melanoma. The melanoma in both cases grew as a pigmented membrane onto the surface of the IOL.

Conclusions: IOL and lens capsule spread of iridociliary melanoma can occur primarily or develop secondarily after plaque brachytherapy of a pseudophakic eye. Since the extent of the melanoma may be uncertain and there is a high likelihood of glaucoma, enucleation is a reasonable option.

Keywords: Intraocular lens; Iridociliary melanoma; Lens capsule; Plaque brachytherapy; Uveal melanoma.

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Conflict of interest statement

Dr. Hans E. Grossniklaus is the Editor-in-Chief of Ocular Oncology and Pathology. Dr. Thomas Aaberg is the Chief Medical Officer of Neurotech Pharmaceuticals. Dr. Jill R. Wells and Dr. Thomas Aaberg are consultants of Castle Biosciences, Inc. Dr. Corrina P. Azarcon has no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
a Slit-lamp photograph of Case 1 showing an iridociliary melanoma. b Higher magnification shows dense pigmentation on the surface of the IOL.
Fig. 2
Fig. 2
a, b Melanoma cells surround the iris leaflets. Higher magnification (×100) shows loosely coherent tumor cells on the anterior and posterior surfaces of the anterior lens capsule (c) and on the surface of the IOL (d) (hematoxylin and eosin, ×5 (a, b), ×100 (c, d)).
Fig. 3
Fig. 3
a Initial slit-lamp photograph of Case 2 shows a tumor at 12-o'clock (white arrow). b Post-plaque brachytherapy, the tumor regressed (white arrow). c A magnified view of the IOL shows a network-like configuration of pigmented cells on its anterior surface. d Illumination of the inferior angle shows a diffuse pigmented mass (black arrow). e Longitudinal UBM scan at 12-o'clock shows a regressed tumor. f Longitudinal UBM scan at 6-o'clock shows a mass in the inferior angle.
Fig. 4
Fig. 4
a Regressed melanoma involving the iris and ciliary body at 12-o'clock. b The inferior angle shows tumor cells on the inferior iridocorneal angle and invasion of the trabecular meshwork. c Melanoma cells are seen on the surface of the lens capsule. d Higher magnification shows the densely pigmented melanoma cells that stained positive for SOX-10 (hematoxylin and eosin, ×10 (a, b), ×25 (c); bleached and stained with SOX-10 with red chromogen, ×100 (d)).
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