Choroidal melanoma edge recurrence 13 years after I125 plaque brachytherapy

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Purpose The vast majority of posterior uveal (choroidal or ciliary body) melanoma local recurrences treatment with plaque brachytherapy occur within 5 years. We report an unusual case of a patient with choroidal melanoma edge recurrence 13 years after I 125 plaque brachytherapy, without evidence of distant metastasis. Case A 70-year-old male was referred 13 years after I 125 plaque brachytherapy with an amelanotic mass along the posterior edge of an atrophic choroidal melanoma scar. Ultrasound showed a dome-shaped choroidal mass with low internal reflectivity. Optical coherence scan showed a choroidal tumor with irregular surface contour (possible ‘lumpy-bumpy’ appearance) and associated subretinal fluid. Vitrector-assisted biopsy confirmed choroidal melanoma with cells with variable size, enlarged nuclei and occasional prominent nucleoli with SOX-10 positivity. Genetic testing revealed BAP1 mutation, GNA11 mutation, chromosome 3 loss and 8q gain, all associated with increased metastatic risk. The patient underwent proton beam radiotherapy. Conclusions This case illustrates a rare late local recurrence of choroidal melanoma with different appearance from the original tumor. It also highlights the diagnostic and prognostic role of transretinal biopsy in confirming the nature of the lesion as a recurrence and the option of proton beam radiation as salvage therapy.

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