Recurrent Ciliary Body Melanoma after Inadequate Systemic Adjuvant Chemotherapy

Abstract

Ciliary body melanoma is diagnosed rarely because of its location and unclear associated symptoms. The existence of orbital recurrent depends on several factors including the width of the intraocular tumor, the diameter, the tumor location and degree of intraocular tumor necrosis.  A sixty-year-old man presented with black mass at the perilimbal area of the left eye since 2 years prior with a decrease in visual acuity. History of incisional biopsy at the same site 1 year before, with pathology presented Malignant Melanoma. The patient rejected enucleation but then completed chemotherapy for 8 months with dacarbazine 1300mg.  After consulted to haemato-oncologist. Recurrent hiperpigmented mass with 8 x 9 x 5 mm in sized, appeared at limbus area 4 months later, and followed by enucleation 1 month in advanced. Gross macroscopic section displayed the mass arose from the ciliary body area, filling in the anterior part of the left eye. Microscopic result was consistent for malignant melanoma. Metastatic workup remains normal, without any lymph node enlargement. The efficacy of systemic chemotherapy alone in intraocular melanoma was still controversy.Dacarbazine is ineffective as a single therapy and reduce the metastasis. Patients with large tumors had more than double the risk of recurrence of patients with smaller tumors.Enucleation still the best therapy for large tumor.Single adjuvant chemotherapy in ciliary body melanoma may be considered inadequate in large size ciliary body melanoma.