Solid organ transplant recipients are known to have an increased risk of developing various malignancies due to long-term immunosuppression. Uveal melanoma, a rare intraocular tumour, has been sporadically reported in this population. Understanding the clinical presentation, management, and outcomes of uveal melanoma in solid organ transplant recipients is crucial for optimising care in this unique subset of patients.
We present two cases of uveal melanoma diagnosed in post solid organ transplant recipients from Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute and Queensland Ocular Oncology Service in Brisbane. Clinical histories, ophthalmological examinations, and treatment modalities (including photodynamic therapy and plaque brachytherapy) are summarised based on medical records.
Case 1 involves a 46-year-old male with a history of multiple renal transplants, presenting with declining visual acuity and a diagnosis of left uveal melanoma (12.5 x 10.0 mm, thickness 5 mm). Initial treatment with photodynamic therapy was followed by plaque brachytherapy due to insufficient tumour reduction. Case 2 describes a 64-year-old female kidney transplant recipient with a new asymptomatic growth in left eye, ultimately diagnosed as uveal melanoma (8.5 x 10.5 mm, thickness 3 mm). This patient underwent primary treatment with plaque brachytherapy, with no evidence of metastasis at last follow-up.
Uveal melanoma in solid organ transplant recipients represents a diagnostic and therapeutic challenge. The rarity of this malignancy in this specific patient population underscores the need for heightened suspicion during ophthalmological evaluations. Treatment decisions must consider the delicate balance between oncological efficacy and immunosuppression management. Long-term follow-up is essential given the potential for metastasis and recurrence. This report highlights the importance of interdisciplinary collaboration between dermatologists, ophthalmologists, and transplant specialists to optimise outcomes in transplant recipients with uveal melanoma. Further studies are warranted to elucidate the underlying mechanisms and refine treatment approaches tailored to this unique patient cohort.