Choroidal melanoma with extensive skeletal metastasis in a 20-year patient

Uveal melanoma (UM) is the most common intraocular tumor in adults, with a dismal prognosis. Once the tumor metastasizes, no treatment options are available, and the patient dies within a few months of diagnosis. Here, we report an unusual case of intraocular choroidal melanoma in a 20-year-old male patient who had multiple skeletal metastasis at the time of presentation. Positron emission tomography–computed tomography revealed a large, lobulated mass in the right orbit, proximal humerus, and the 5 th rib along the costovertebral junction. Histopathology revealed epithelioid cell malignant melanoma with large areas of necrosis and numerous infiltrating lymphocytes. An early-occurring mutation in GNA11 was observed, along with monosomy 3. Immunohistochemistry revealed a loss of nuclear BAP1 and c-kit expression, while it was positive for other immune markers. This is a rare case of UM with metastasis to the humerus and rib at the time of presentation, which, to our knowledge, has not been documented earlier.