A 72-year-old man came to the ophthalmology department for loss of vision in the left eye (LO) that had been present for one month. By way of background, the patient had been treated for prostate carcinoma 10 years earlier with radiotherapy without relapse at the time of the study. Visual acuity in the right eye (OD) was 5/10 and no light perception in the OI. Intraocular pressure was 18 mmHg in OD and 12 mmHg in OI. Slit-lamp examination showed a ++ nuclear cataract in both eyes. The fundus examination in the OD showed no alterations, but in the OI it was not visible due to a haemovitreous. Ultrasound showed a lobulated lesion occupying 4/5 of the vitreous chamber. The hypothesis of CM or metastatic lesion was put forward, so a search for a primary lesion was performed. Thoracic-abdominal CT scan and liver tests were normal. Given the suspicion of a malignant lesion, a PET/CT scan was performed, which was positive in the eye (SUVmax: 7.2), liver (SUVmax: 5.7) and right pulmonary hilum (SUVmax: 3.5). After the PET/CT scan we reviewed the abdominal CT scan, without identifying liver lesions, only a dubious nodular alteration of poorly delimited density and difficult to interpret due to its small size, not accessible for biopsy by ultrasound or CT scan. Magnetic resonance imaging (MRI) of the liver was considered, but was rejected due to the small size of the lesion. Enucleation was decided because of the need for pathological anatomy to confirm the diagnosis prior to chemotherapy. The severity of the pathology, type of surgery and no possibility of visual recovery in the affected eye were reported. The pathological anatomy showed a large spindle cell MC (17*17 mm) and in the immunohistochemical study intense cytoplasmic positivity for MELAM-A and HMB45.

The patient, who at the end of the diagnostic process had an ECOG-1 (quality of life according to the Eastern Cooperative Oncology Group scale) due to vision loss, started palliative treatment with dacarbazine at a dose of 850 mg/m2 every 3 weeks in April 2011, with excellent tolerance. In June 2011, he was re-evaluated and presented radiological progression of the liver, not detected in CT, but detected in PET/CT.
In June 2011, she started 2nd line treatment with ipilimumab (3 mg/kg every 3 weeks - 4 doses), with preservation of general condition (ECOG1), completing treatment without side effects. Hepatic progression was again detected (at week 12 and 16 of treatment, as stipulated in the ipilimumab evaluation protocol), identified on CT and PET/CT scans.
In November 2011, he started 3rd line of treatment with fotemustine at 75 mg/m2 with induction dose, due to preservation of general condition, without completing the planned treatment until the planned radiological evaluation, due to general deterioration. She died in February 2012 (11 months after diagnosis).

