Surgical management of pulmonary metastases secondary to uveal melanoma: a case series

Uveal melanoma is a rare malignancy with a strong propensity for late metastases, most commonly affecting the liver. Pulmonary metastases are less frequent and can manifest years or even decades after the primary diagnosis. This study presents three cases of pulmonary metastases secondary to uveal melanoma, highlighting clinical presentations, treatment strategies, and outcomes following surgical intervention. A retrospective analysis of 132 patients diagnosed with uveal melanoma between 2009 and 2022 at one institution was conducted. Clinical and pathological data were reviewed to assess primary tumor characteristics, metastatic patterns, treatment approaches, and patient outcomes. Three patients were identified with pulmonary metastases, diagnosed at least a decade after primary tumor treatment. The metastatic presentation varied, with one patient exhibiting bilateral multiple nodules, while the other two had solitary pulmonary lesions. All patients underwent video-assisted thoracoscopic surgery wedge resection, confirming metastatic melanoma. Two patients remained disease-free following resection, while one developed systemic progression with small bowel metastases, ultimately leading to fatal complications. Surgical resection of isolated pulmonary metastases from uveal melanoma may offer clinical benefit in highly selected patients. While not a standard treatment modality, pulmonary metastasectomy may be appropriate in selected patients and can be considered within the context of a multidisciplinary evaluation.