Sequential Bilateral Choroidal Malignant Melanoma With Unique BAP1 Positivity Managed With Iodine-125 Plaque Radiotherapy

Uveal melanomas are almost always unilateral. Bilateral presentation is extremely rare, about 1 in 80 million/year. This report presents the case of a 40-year-old man who developed bilateral choroidal melanoma sequentially. The right eye with a de novo juxtapapillary choroidal melanoma was managed with 18-mm notched I125 plaque with full distribution. Eighteen months later, transformation of a choroidal nevus into a melanoma was detected in the fellow eye, and was treated with 12-mm round I125 plaque with full distribution. The patient tested positive for BAP1 germline mutation (c.659+1G >A p.?; rs2153227622). After three years of follow-up, both tumors were regressed and the patient was receiving immunotherapy for related liver metastasis.