Ring Melanoma: from Vitrectomy to Enucleation

Purpose: To report disease progression of ring melanoma. Methods: A comprehensive chart review was conducted. Results: A 75-year-old male presented with persistent floaters and reduced visual acuity in the right eye. On diagnostic and therapeutic vitrectomy, there were melanoma cells on cytopathology, but no visible intraocular mass. Systemic work-up was negative. Recurrence of floaters led to repeat vitrectomy which yielded similar findings. The patient’s visual acuity decreased further, and neovascular glaucoma developed without evidence of intraocular mass. Thirteen months after initial presentation, imaging revealed ciliary body thickening and a large posterior mass. Enucleation confirmed ciliary body ring melanoma with diffuse iris involvement and malignant retinal invasion. The choroid was not involved. Conclusion: Ring melanoma is a rare disease process which can evade clinical examination and various imaging modalities. This case depicts the disease course of a ring melanoma from subclinical stages to robust ocular infiltration.