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Ophthalmology and Visual Sciences

Iris Melanoma

Iris Melanoma

Category(ies): Cornea, Glaucoma, Iris
Contributor: David A. Ramirez, MD; Mark A. Greiner, MD
Photographers: Jody Troyer, CRA; Laura Fuhrmeister

93-year-old woman presented with progression of longstanding iris nevus. Her original presentation in 2005 is shown in Figure 1. Figures 2 and 3 demonstrate frank enlargement of the primary lesion at 6 o'clock and local metastasis, with erosion through the angle into the sclera at 8o'clock (Figures 4 and 5). Pigmented keratic precipitates are suspicious for anterior chamber seeding (Figure 6). High frequency anterior segment imaging demonstrates further angle invasion (arc of high reflectivity; Figure 7).

Iris Melanoma lower portion of eye
Figure 1. Primary lesion presentation, 2005
Iris Melanoma lower portion of eye and left side
Figure 2. Evolution of primary lesion, 2019
Elevation of the iris melanoma
Figure 3. Elevation of the iris melanoma
 Invasion of the iris melanoma through the sclera
Figure 4. Invasion of the iris melanoma through the sclera, with overlying conjunctiva
Dense pigmentary infiltration of the angle
Figure 5. Dense pigmentary infiltration of the angle
Pigmented keratic precipitates on the corneal endothelium
Figure 6. Pigmented keratic precipitates on the corneal endothelium, thought secondary to melanoma seeding the anterior chamber.
High frequency anterior segment ultrasonography showing high internal reflectivity
Figure 7. High frequency anterior segment ultrasonography showing high internal reflectivity, suspicious for malignancy, in the area of the lesion.

Contributor: Andrew Doan, MD, PhD

3 patients with iris melanomas. The last patient had a recurrence 20 years later after an iridocyclectomy.


Contributor: John Chen, MD, PhD
Photographer: D. Brice Critser, CRA

81-year-old female with a slowly enlarging iris lesion found to be an iris melanoma originating from an iris nevus.