Melanoma-Associated Retinopathy

History of Present Illness

A 30-year-old male with a history of melanoma presents for the first time to the eye clinic complaining of some distortion of images in the left eye (OS). He noticed that in his OS he now sees “through a screen of colored squiggly lines and white dots.” It was hard for the patient to look at dark backgrounds. Initially, these symptoms were intermittent and then became constant within a week of onset.

Given the history of nyctalopia in the setting of a normal fundus, electroretinogram (ERG) is pursued ( Fig. 39.2 ).

Questions to Ask

• Are you sure this is a new symptom?

• Is there a family history of eye or vision problems?

• Are you otherwise healthy?

The patient was sure this was of acute onset, and there was no family history of retinal degenerations. He had presented a month and a half prior with a left neck node. Fine needle aspiration was positive for melanoma of unknown primary site. One month before presentation he underwent bulky left posterior triangle lymphadenopathy followed by left radical neck dissection and parotidectomy. He had metastatic melanoma involving 3 of 12 lymph nodes. Treatment had not yet been initiated at the time of presentation with visual symptoms. There were no other intercurrent illnesses. He had no history of autoimmune disease.