The Absent-Minded Professor: An Unusual Complication Of Melanoma

Main Category: Melanoma / Skin Cancer
Also Included In: Cancer / Oncology
Article Date: 07 Jan 2009 - 3:00 PDT

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The patient is a geology professor who was evaluated in our multidisciplinary cutaneous oncology clinic for a new diagnosis of malignant melanoma with subsequent development of metastatic disease and melanoma-associated retinopathy.

History

The patient initially presented to our clinic in 1998. At that time, he was a 57-year-old geologist with a history of extensive sun exposure who had a pigmented lesion biopsied from his right posterior auricular region. The pathology revealed a Clark's level IV, 1.28-mm malignant melanoma.

He subsequently underwent wide local excision with concurrent sentinel lymph node biopsy. The reexicison specimen revealed no residual melanoma, and three lymph nodes were removed, none of which showed any evidence of metastatic melanoma. After much discussion with the patient, he elected to enroll on an adjuvant clinical trial of interferon with or without tamoxifen. He was randomized to receive interferon alone. He received interferon at 3 million units subcutaneously three times a week for a total of 18 months. The patient tolerated this treatment well, with only fatigue as a complaint. He was then followed with close observation.

He did very well until May of 2002, when he began to complain of trouble with his vision. He reported yellow and white flashing lights and floaters. An optometrist initially evaluated him but found no etiology for these symptoms. Magnetic resonance imaging (MRI) of the brain was performed in June 2002 to further evaluate these symptoms.

The scans showed no evidence of metastatic melanoma. Despite this initial negative workup, the patient continued to report worsening vision with persistent flashing lights as well as new symptoms of memory loss. He was therefore evaluated by ophthalmology. Because of his symptoms, there was concern about lymphoma as a possible cause, and therefore a vitreous biopsy was performed. The biopsy was interpreted as vitritis. The pathology revealed inflammatory white cells, no definitive pigment cells, and no lymphoma, and all cultures were negative.

RAGINI KUDCHADKAR, MD, RENE GONZALEZ, MD, WILLIAM ROBINSON, MD, PhD, MAUDE BECKER, RN, KRISTA TREICHEL, RN, ALAN KIMURA, MD, KARL LEWIS, MD

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