Combination intravitreous melphalan and bevacizumb for cutaneous metastatic melanoma to the vitreous and retina

PURPOSE: Cutaneous melanoma metastatic to the vitreous/retina is rare but increasingly common. Due to the potential of recurrent disease with current treatment options and the propensity for these eyes to develop neovascularization, these eyes can pose a treatment challenge and novel management strategies are needed. This case series explores the use of combination, sequential intravitreous melphalan and bevacizumab. OBSERVATION: Two eyes of two patients with cutaneous melanoma metastatic to the vitreoretina were eye treated with combination intravitreous melphalan (10-30 mcg) and bevacizumab (1.25 mg) given sequentially during the same office visit, at monthly intervals. Both cases had control of disease at 7- and 12-months follow up. Furthermore, treatment reversed neovascular glaucoma and dramatically improved vision in the eye of one patient; and stabilized vision without the development of neovascularization in the eye of the other patient. There were no ocular adverse events noted in either eye. CONCLUSIONS AND IMPORTANCE: Combination, sequential intravitreous melphalan and bevacizumab is well-tolerated and an attractive approach for treating eyes with intraocular metastatic melanoma.