Clinical and immunocytochemical findings in a case of melanoma-associated retinopathy.

Abstract

To describe an unusual case of melanoma-associated retinopathy (MAR). Retrospective, observational case report and experimental study. A 61-year-old man with a history of cutaneous melanoma, acquired bilateral central scotomas, and night blindness. Serial full-field electroretinography (ERG) and Goldmann perimetry were performed. Serum was screened for cancer-associated retinopathy (CAR) antibodies by Western blotting. Sections of human and rat retina were examined by immunofluorescence microscopy to determine whether retinal cells were reactive with this patient's serum. A metastatic workup was performed. Electroretinography, Goldmann visual field testing, and immunocytochemistry were performed. The results were as follows: (1) The ERG showed a profound loss of the b-wave amplitude and a "negative" b-wave characteristic of congenital stationary night blindness; (2) a central scotoma and peripheral constriction were identified on Goldmann visual field tests; (3) as in other patients with MAR, bipolar cells in human and rat retinas were immunolabeled with this patient's serum; and (4) a previously unsuspected focus of metastatic melanoma was discovered. Recognition of this condition may help to identify an occult focus of metastatic melanoma.