To report uveal melanoma (UM) metastasis to the contralateral ocular and periocular structures.
Retrospective study.
Thirteen patients with UM metastasis to the contralateral ocular and periocular structures were included.
Clinical records were reviewed retrospectively.
The development and time to onset of contralateral ocular and periocular metastasis, systemic metastasis, and death.
Of the 13,000 treated UM cases, 13 patients were diagnosed with UM metastasis to the contralateral ocular and periocular structures. Mean patient age at primary UM diagnosis was 60 years (median 60, range 37-87 years). The primary uveal melanoma was in the choroid (n=11) or ciliary body (n=2) and was treated with brachytherapy (n=11), proton beam radiotherapy (n=1), or enucleation (n=1). Systemic metastasis developed in 11 patients (85%) at a mean of 66 months (median 34, range 12 – 216 months) after diagnosis of the primary UM. All 11 patients (100%) had liver metastasis and 8 (62%) also had extra-hepatic metastasis. The sites of metastasis to the contralateral ocular or periocular structures included the choroid in 4 (31%), orbit in 7 (54%), and eyelid in 2 (15%) patients. One patient with eyelid metastasis had concurrent conjunctival nodule. Mean time to diagnosis of contralateral ocular or periocular metastasis was 94 months (median 48, range 9 – 375 months). Contralateral choroidal metastasis was multifocal in 3 of 4 patients (75%). Of 7 patients with orbital metastasis, 5 had extraocular muscle involvement with restricted ocular motility. Treatment for contralateral choroidal metastasis included brachytherapy (n=2), transpupillary thermotherapy (n=1), and observation (n=1). Treatment for contralateral periocular (orbit/eyelid) metastasis was excision (n=5), external beam radiotherapy (n=2) and observation (n=2). Of 13 patients, death was documented in 11 cases at mean 17 months (median 9, range 3 – 54 months), from systemic UM metastasis (n=10) or unrelated cause (n=1).
Metastasis from UM to the contralateral ocular and periocular structures is rare and generally occurs in patients with disseminated metastasis. Orbital tissue is the most common site of involvement and these patients have short life expectancy.

Copyright © 2021. Published by Elsevier Inc.

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