title: Post-menopausal bleeding: a rare presentation of metastatic uveal melanoma.
abstract: Uveal melanoma differs from cutaneous melanoma in many ways, including its pattern of metastasis, and exhibits latency with clinical evidence of metastasis sometimes appearing many years after primary diagnosis. Most patients develop metastasis within the liver, but some may present with metastasis to other sites. We report a case of uveal melanoma that presented with post-menopausal bleeding due to metastasis. Further investigation revealed widespread metastatic disease and the patient was not fit for chemotherapy. She died two months after presentation: autopsy revealed metastases in many sites, including the uterus, right ovarian fibroma, kidney, mesentery, liver, lung, thyroid, bone marrow and skin. The immediate cause of death was cardiac tamponade due to a malignant effusion secondary to cardiac metastasis. This case illustrates the widespread metastatic potential of uveal melanoma and highlights the potential for unusual presentation of metastatic disease from this eye tumor.
authors.affiliation: Cellular Pathology, Preston Hall Hospital, Maidstone and Tunbridge Wells NHS Trust, Kent, UK.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Coutts
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Borthwick
authors.forename: John L
authors.initials: JL
authors.lastname: Hungerford
authors.forename: Ian A
authors.initials: IA
authors.lastname: Cree
mesh_terms: D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000556:secondary; D005260:Female; D006338:Heart Neoplasms / Q000556:secondary; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008545:Melanoma / Q000473:pathology* / Q000556:secondary; D009362:Neoplasm Metastasis; D017698:Postmenopause; D014592:Uterine Hemorrhage / Q000209:etiology*; D014604:Uveal Neoplasms / Q000473:pathology*