title: Multiple simultaneous choroidal melanomas arising in the same eye: globe salvage by radiotherapy.
abstract: OBJECTIVE
  Multiple choroidal melanomas arising in the same eye is a very rare entity, usually leading ophthalmologists to entertain other diagnoses. Historically, the only available treatment reported for this rare entity was enucleation. In this study we demonstrate in a series of patients with multiple simultaneous choroidal melanomas that eye salvage is possible using a variety of radiotherapy techniques.
  
  
  METHODS
  Both patients presented with two simultaneous choroidal melanomas in one eye. The first patient was only 30 years old and presented with two largely amelanotic tumours with large exudative retinal detachment. Cytology from fine needle aspiration biopsies from both tumours with immunohistochemistry confirmed two separate melanomas. Sequential radioactive iodine plaque brachytherapy led to regression of both tumours. The second, older patient's two tumours both had the typical appearance of choroidal melanoma and he underwent proton beam irradiation to the entire field leading to tumour regression.
  
  
  CONCLUSIONS
  Multiple choroidal melanomas can rarely arise simultaneously in the same eye, and despite their variable appearance, a definitive diagnosis can be aided by cytology and immunohistochemistry in atypical-appearing cases. While all other previously reported cases have necessitated enucleation, we demonstrate that globe salvage is possible using either proton beam irradiation to the entire tumour field, or with sequential radioactive plaque brachytherapy.
authors.affiliation: Department of Ophthalmology, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Zhang
authors.affiliation: Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA.
authors.forename: Thanos D
authors.initials: TD
authors.lastname: Papakostas
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Arnold W
authors.initials: AW
authors.lastname: Malcolm
authors.affiliation: Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.|Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Kristin K
authors.initials: KK
authors.lastname: Ancell
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Charles V
authors.initials: CV
authors.lastname: Biscotti
authors.affiliation: Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA.
authors.forename: Evangelos S
authors.initials: ES
authors.lastname: Gragoudas
authors.affiliation: Department of Ophthalmology, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA.|Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.|Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Daniels
mesh_terms: D000328:Adult; D001918:Brachytherapy; D002830:Choroid Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D018328:Melanoma, Amelanotic / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary; D061766:Proton Therapy; D016879:Salvage Therapy
chemical_list: D007457:Iodine Radioisotopes