A case of cutaneous melanoma metastatic to the ciliary body and choroid with complete regression via systemic dual checkpoint inhibitor therapy

Abstract Background Cutaneous melanoma is the leading cause of death from cutaneous malignancy and tends to metastasize lymphatically and hematogenously to the lung, liver, brain, and bone; it is a rare source of metastatic disease to the eye. Herein we provide a case report of cutaneous melanoma metastatic to the ciliary body and choroid involving clinical examination, slit lamp photography, and B-scan ultrasonography. Result A 55-year-old female with known metastatic cutaneous melanoma presented with pain, a large ciliochoroidal mass, visual decline, and diffuse intraocular inflammation. The examination and testing were consistent with intraocular metastasis from her primary cutaneous melanoma. Given the extent of intraocular disease, the patient elected for enucleation of the involved eye. The patient’s intraocular disease demonstrated significant regression on combination immunotherapy with nivolumab and ipilimumab and surgery was subsequently deferred. The metastatic ciliochoroidal lesion ultimately regressed completely with systemic dual checkpoint inhibitor therapy. Conclusion Combination therapy with ipilimumab and nivolumab immunotherapy may be effective in the treatment of aggressive intraocular metastatic cutaneous melanoma.