S5535 An Unusual Disease With a Common Presentation: A Case of Metastatic Uveal Melanoma to the Liver

Introduction: Uveal melanoma is a rare disease with an incidence of 0.0005% but is the most common primary malignancy of the eye in adults. Uveal melanoma metastasizes in around 50% of patients, with the liver being the first site of metastasis in 90% of cases, making regular surveillance critical. We report a case of metastatic uveal melanoma to the liver complicated by abdominal compartment syndrome. Case Description/Methods: A 66-year man with a past medical history of stage 1 uveal melanoma with enucleation 2018, alcohol use disorder and steatotic liver disease presented by private transport to the hospital with abdominal distension, fatigue, and early satiety over the preceding 6-8 weeks. The patient had been consuming 2-6 alcoholic beverages daily for 50 years. Initial laboratory results showed elevated blood urea nitrogen, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, creatinine and bilirubin. He had a firm and palpable abdominal mass extending beyond the right upper quadrant into the left and right lower abdomen. A lack of conjugate gaze in the right eye was noted secondary to prosthetic eye use. He underwent routine liver surveillance from 2018-2020 before being lost to follow-up. His 2020 MRI showed no metastasis to the liver and no hepatic cysts. Imaging showed an ill-defined posterior right hepatic lobe mass. The attempt to do a paracentesis was unsuccessful due to very small ascites. Liver core biopsy indicated metastatic uveal melanoma after exhaustive staining. A radiation plan was discussed. Unfortunately, he developed abdominal compartment syndrome with acute renal failure and elected for home hospice where he passed 2 days later. Discussion: Typically, patients with this social history and phenotype have alcohol-related cirrhosis with ascites. However, this patient had recurrent metastatic uveal melanoma, which has a very poor prognosis. When detected in the eye, surveillance is recommended at intervals of 4 to 6 months, based on the fast doubling time of untreated liver metastasis. Treatment is limited. A standard of care is only available for HLA-A*02:01 positive patients with metastases who can receive ipilimumab (monoclonal antibody). Response rates vary from 5% to 10%. This case highlights the importance of a thorough physical exam, history taking, and the avoidance of type II errors. Finally, ensuring that regular surveillance take place in patients with uveal melanoma.