Coexistence of choroidal melanoma and rhegmatogenous retinal detachment: a case report and literature review

INTRODUCTION AND IMPORTANCE: The simultaneous occurrence of rhegmatogenous retinal detachment (RRD) and choroidal melanoma is extremely rare, and diagnosis of choroidal melanoma in RRD patients is challenging. As a result, choroidal masses in RRD patients tend to be overlooked, resulting in delayed treatment. The authors report a rare case presenting with simultaneous choroidal melanoma and RRD, and the authors review the related literature. CASE PRESENTATION: A 45-year-old Thai man who presented with inferior RRD and choroidal elevation in the left eye was examined using fundoscopy and ultrasonography. The presumptive diagnosis was simultaneous RRD and haemorrhagic choroidal detachment (CD). Vitrectomy and external drainage were attempted but were unsuccessful in draining fluid from the presumed haemorrhagic CD. Although the retina was reattached, the choroidal elevation remained unchanged. After being lost to follow-up, the patient returned later with severe proptosis in the left eye. MRI findings suggested a presumptive diagnosis including choroidal melanoma and choroidal metastasis, which choroidal melanoma was later confirmed through histopathological examination after exenteration. CLINICAL DISCUSSION: Important clinical clues were provided for distinguishing between choroidal melanoma and haemorrhagic CD in cases of coexisting RRD. CONCLUSIONS: In the differential diagnosis of RRD with suspicious choroidal elevation, the possibility of the presence of choroidal melanoma should be considered. In particular, in cases where haemorrhagic CD fails to drain during surgery, the possibility of underlying choroidal melanoma should be investigated.