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Necrotic Eruption of an Inflammatory Melanoma

To identify the key insights or developments described in this article
1 Credit CME

A 64-year-old male individual presented with blurry vision and was found to have an amelanotic choroidal mass with vitritis (Figure, A). Systemic anti-inflammatory medications were started and led to clear vision and stability in the mass. Ten months after presentation, the patient developed sudden-onset floaters and was found to have a white vitreous eruption emanating from the choroidal lesion (Figure, B). A vitreous biopsy demonstrated background necrosis, scattered histiocytes, and atypical cells (Figure, B, inset). A subsequent fine-needle aspiration biopsy (FNAB) of the choroidal mass showed atypical melanocytes consistent with a choroidal melanoma. Despite the stability in the size of the melanoma and widespread necrosis, the melanocytes within the choroidal FNAB appeared to be viable, and the decision was made to treat the melanoma. Eighteen months after proton-beam radiation, the patient maintained good vision without melanoma recurrence. Inflammatory melanomas can present with necrotic vitreous eruptions and may contain viable tumor cells requiring treatment.

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Article Information

Corresponding Author: Thamanna Nishath, MSPH, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195 (tnishath@uw.edu).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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