A rare case of choroidal melanoma with a lump in the nape of neck

A 70-year-old man reported a gradual decline in vision in his left eye over the past four months. Upon slit-lamp examination, the left eye showed a sluggish pupillary response to light, a posterior subcapsular cataract, and a pigmented choroidal mass. Due to the presence of the choroidal mass, enucleation with placement of a silicone ball implant was recommended. Histopathological analysis of the eye revealed a choroidal malignant melanoma of the mixed cell type, extending into the ciliary body. It is important to distinguish melanomas from benign pigmented lesions such as choroidal nevi, congenital hypertrophy of the retinal pigment epithelium, and choroidal hemorrhages. Some choroidal nevi can closely resemble small melanomas, making diagnosis challenging. When ocular melanoma metastasizes, the five-year survival rate drops to around 15%. The somatic mutations and prognosis associated with intraocular melanoma differ significantly from those of cutaneous melanoma. The presence of choroidal melanoma alongside a lump in the nape of the neck is an extremely rare finding in ophthalmic pathology.