Locally Invasive Diffuse Iris Ring Melanoma Presenting as Unilateral Severe Glaucoma: Case Report and Review of Molecular Genetics

• Published in: Case reports in oncology Vol. 14; no. 1; pp. 403 - 410
• Main Authors: Naguib, Mina M., Chévez-Barrios, Patricia, Orengo-Nania, Silvia, Schefler, Amy C.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01-01-2021; Karger Publishers
• Subjects: Case Report; Case reports; Cataracts; diffuse iris ring melanoma; Gene expression; gene expression assay; Glaucoma; Iris; Melanoma; Metastasis; molecular genetics; neovascular glaucoma; Optic nerve; Retina; Ultrasonic imaging; Gene expression assay; Neovascular glaucoma; Molecular genetics; Diffuse iris ring melanoma
• ISSN: 1662-6575; 1662-6575
• DOI: 10.1159/000512012

We report the clinical history and histopathological findings in a case of diffuse iris ring melanoma (DIM) and review the most recent literature and modern molecular genetics of this entity. An 85-year-old Hispanic man presented with severe unilateral glaucoma, managed at an outside institution for 2 years prior to presentation. Diffuse pigmentation was noted in the angle, on the intraocular lens implant, and in the vitreous without clear demonstration of a mass on ultrasound biomicroscopy. Workup for metastatic cutaneous melanoma was negative. Histopathological examination of the enucleated eye revealed a mixed cell type iris ring melanoma with diffuse intraocular involvement. Gene expression profiling (GEP) revealed a class 2 molecular signature indicating a very high risk for metastases. Unilateral glaucoma presenting with marked pigmentation in the anterior chamber angle should be managed as melanoma until proven otherwise. Iris ring melanomas are known to have an aggressive clinical course, and recent molecular analyses indicate that they are likely primarily GEP class 2 with a very poor prognosis, similar to the majority of ciliary body melanomas.