A case of cutaneous melanoma metastatic to the vitreous cavity: possible pathomechanism and review of the literature

  • Gesine B. JaissleEmail author
  • Peter Szurman
  • Jens Martin Rohrbach
  • Faik Gelisken
  • Karl Ulrich Bartz-Schmidt
Short Communication



Isolated vitreous metastases are extremely rare and the pathogenesis of metastasis is still unclear. Here we present the detailed description of the disease progression in a 68-year-old patient with vitreous seeding of a metastatic cutaneous melanoma beginning at a very early stage.


Interventional case report and review of the literature.


The initial retrohyaloidal metastatic lesion was identified adjacent to a small epiretinal hemorrhage. As the disease progressed golden brown spherules appeared in the posterior vitreous emanating from the area of the lesion. Further progression led to a dense metastatic infiltration of the entire vitreous cavity and a decline of the visual acuity to 20/1200. Diagnostic and therapeutic pars plana vitrectomy was performed to confirm the diagnosis and preserve the eye and useful vision.


For the first time the formation of vitreous metastases derived from cutaneous melanoma was carefully studied beginning at a very early stage. This made it possible to analyze the rare mechanism of vitreous metastasis, which has not been conclusively known till now. The features of metastatic cutaneous melanoma to the vitreous are discussed in context of a review of the literature that resulted from the study of 17 patients with 22 affected eyes.


Vitreous metastases Ocular metastases Cutaneous melanoma Pathomechanism Vitrectomy 



The authors thank Dr. Anja Ulmer, MD and Prof. Dr. Gerhard Fierlbeck, MD (University Dermatology Clinic, University of Tuebingen, Germany) for immunomagnetic peripheral blood analysis and for critical review of the manuscript and Dr. Barbara Wallenfels-Thilo for excellent editorial assistance.


  1. 1.
    Apte RS, DiBernardo C, Pearlman JR, Patel S, Schachat AP, Green WR, Gehlbach P (2005) Retinal metastasis presenting as a retinal hemorrhage in a patient with adenocarcinoma of tha caecum. Arch Ophthalmol 123:850–853PubMedCrossRefGoogle Scholar
  2. 2.
    Best SJ, Taylor W, Allen JP (1990) Metastatic cutaneous malignant melanoma of the vitreous and retina. Aust NZ J Ophthalmol 18:397–400Google Scholar
  3. 3.
    Bowman CB, Guber D, Brown III CH, Curtin VT (1994) Cutaneous malignant melanoma with diffuse intraocular metastases. Arch Ophthalmol 112:1213–1216PubMedGoogle Scholar
  4. 4.
    Chambers AF, MacDonald IC, Schmidt EE, Koop S, Morris VL, Khokha R, Groom AC (1995) Steps in tumor metastasis. New concepts from intravital videomicroscopy. Cancer Metastasis Rev 14:279–301PubMedCrossRefGoogle Scholar
  5. 5.
    Char DH, Schwartz A, Miller TR, Abele JS (1980) Ocular metastases from systemic melanoma. Am J Ophthalmol 90:702–707PubMedGoogle Scholar
  6. 6.
    Cole EL, Zakov ZN, Meisler DM, Tuthill RJ, McMahon JT (1986) Cutaneous malignant melanoma metastatic to the vitreous. Arch Ophthalmol 104:98–101PubMedGoogle Scholar
  7. 7.
    Fishman ML, Tomaszewski MM, Kuwabara T (1976) Malignant melanoma of the skin metastatic to the eye. Frequency in autopsy series. Arch Ophthalmol 94:1309–1311PubMedGoogle Scholar
  8. 8.
    Galland F, Balansard B, Conrath J, Forzano O, Ridings B (2004) Métastase oculaire d’un mélanome cutané. J Fr Ophtalmol 27:166–168PubMedCrossRefGoogle Scholar
  9. 9.
    Gündüz K, Shields JA, Shields CL, Eagle RC (1998) Cutaneous melanoma metastatic to the vitreous cavity. Ophthalmology 105:600–605PubMedCrossRefGoogle Scholar
  10. 10.
    Hitchings RA, Tripathi RC (1976) Vitreous opacities in primary amyloid disease. A clinical, histochemical, and ultrastructural report. Br J Ophthalmol 60:41–54PubMedGoogle Scholar
  11. 11.
    Pollock SC, Awh CC, Dutton JJ (1991) Cutaneous melanoma metastatic to the optic disc and vitreous. Arch Ophthalmol 109:1352–1354PubMedGoogle Scholar
  12. 12.
    Rager EL, Bridgeford EP, Ollila DW (2005) Cutaneous melonoma: update on prevention, screening, diagnosis, and treatment. Am Fam Physician 72:269–276PubMedGoogle Scholar
  13. 13.
    Robertson DM, Wilkinson CP, Murray JL, Gordy DD (1981) Metastatic tumor to the retina and the vitreous cavity from primary melanoma of the skin. Treatment with systemic and subconjunctival chemotherapy. Ophthalmology 88:1296–1301PubMedGoogle Scholar
  14. 14.
    Shankar J, Damato BE, Hiscott P (2002) Palliative vitrectomy for intraocular metastasis from cutaneous melanoma. Eye 16:660–662PubMedCrossRefGoogle Scholar
  15. 15.
    Siegel MJ, Dalton J, Friedman AH, Strauchen J, Watson C (1989) Ten-year experience with primary ocular ‘reticulum cell sarcoma’ (large cell non-Hodgkin’s lymphoma. Br J Ophthalmol 73:342–346PubMedGoogle Scholar
  16. 16.
    Soheilian M, Mirbabai F, Shahsavari M, Parvin M, Manieei F (2002) Metastatic cutaneous melanoma to the vitreous cavity masquerading as intermediate uveitis. Eur J Ophthalmol 12:324–327PubMedGoogle Scholar
  17. 17.
    Spraul CW, Martin DF, Hagler WS, Grossniklaus HE (1996) Cytology of metastatic cutaneous melanoma to the vitreous and retina. Retina 16:328–332PubMedGoogle Scholar
  18. 18.
    Ulmer A, Schmidt-Kittler O, Fischer J, Ellwanger U, Rassner G, Riethmuller G, Fierlbeck G, Klein CA (2002) Immunomagnetic enrichment, genomic characterization, and prognostic impact of circulating melanoma cells. Clin Cancer Res 10:531–537CrossRefGoogle Scholar
  19. 19.
    Verbraeken H (1996) Diagnostic vitrectomy and chronic uveitis. Graefe’s Arch Clin Exp Ophthalmol 234:S2–S7CrossRefGoogle Scholar
  20. 20.
    Wagenmann A (1900) Ein Fall von multiplen Melanosarkomen mit eigenartigen Complicationen an beiden Augen. Dtsch Med Wochenschr 16:262–263CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Gesine B. Jaissle
    • 1
    Email author
  • Peter Szurman
    • 1
  • Jens Martin Rohrbach
    • 1
  • Faik Gelisken
    • 1
  • Karl Ulrich Bartz-Schmidt
    • 1
  1. 1.Department for Vitreoretinal SurgeryUniversity Eye HospitalTuebingenGermany

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