Massively invasive diffuse choroidal melanoma.

A 74-year-old woman was found to have increasing proptosis in a blind, painful left eye with neovascular glaucoma. Uveal malignant melanoma with massive orbital involvement was diagnosed, and the patient underwent orbital exenteration, with preoperative and postoperative orbital irradiation. The tumor was a mixed-cell, diffuse uveal malignant melanoma with involvement of the optic nerve adjacent to the line of surgical transection and of the optic nerve sheath. Subsequently, the cerebrospinal fluid cytology disclosed cells consistent with malignant melanoma, despite the absence of neurologic signs or symptoms. Cerebrospinal fluid cytology is essential in such cases, and ultrasonography is of value.