This 53YO male presented on 1/7/21 with a medium-sized posterior pole uveal malignant melanoma. Lipofuscin was noted along the surface of the tumor. Optos fundus autofluorescence (FAF) showed variable hyper- and hypo-FAF. The lesion measured 8 x 11 mm and was 5.5mm thick. Despite its macular location, vision was 20/30.
The patient underwent I-131 plaque radiotherapy. About four months postoperatively, the tumor began to flatten (4.2mm thick), with resolving lipofuscin, coarse pigment clumping, and a generalized decrease in FAF. Vision remained stable.
Genetic testing revealed a Class 2 PRAME-negative lesion.
Learning Points:
Close to 75% of patients with a Class 2 lesion will experience clinical metastasis within 5 years. PReferentially expressed Antigen in MElanoma (PRAME) is a gene that can be aberrantly expressed in some malignancies. Its positivity may indicate a shorter time to metastatic disease, but its negativity does not typically alter prognosis.
