Regression of choroidal melanoma after primary chemotherapy

Purpose To describe the local regression of an intraocular choroidal melanoma after primary chemotherapy with fotemustine. Methods A 30 y.o. young man presented with drop of visual acuity in his lest eye to 0,8. The right eye was unremarkable with VA 1,2. On the same time he developed upper abdominal pain. On ophthalmic examination a circumpapillary choroidal melanoma was detected with possible optic nerve infiltration on his left eye. Ultrasound and MRI scan of the upper abdomen revealed a diffuse metastatic liver disease. Results In consultation with the department of oncology it was decided to prescribe systemic chemotherapy with fotemustine. After 4 cycles of chemotherapy, there was impressive local regression of the choroidal tumour and the liver metastases. Unfortunately after the initial response and the stable intraocular situation, there was tumour progression in other sites such as subcutaneous and lung metastases. After administration of some cycles of cisplatin as an alternative regime, the patient succumbed to the metastatic disease. Conclusion This case demonstrates that intravenous fotemustine can be effective for a limited time period as a primary treatment option in a case of choroidal melanoma, without other local treatment.