Choroidal Metastasis Presenting As Anterior and Posterior Scleritis: A Rare Manifestation of a Previously Unknown Metastatic Cutaneous Melanoma
Bibliographic record
Abstract
Choroidal metastasis from occult cutaneous melanoma is rare and can masquerade as ocular inflammation. A 70‑year‑old man with sectoral anterior scleritis was found on multimodal imaging to have a solitary choroidal mass with mild periscleral fluid, prompting systemic evaluation that uncovered colonic polyps that, on histopathology, contained metastatic melanoma, a scalp primary, and widespread visceral, nodal, and intracranial metastases. Tumour cells stained HMB‑45, Melan‑A, and SOX10 positive, AE1/AE3 negative, and carried an NRAS‑Q61 mutation with wild‑type BRAF, confirming cutaneous origin. Combined immune‑checkpoint blockade and ocular‑plus‑cerebral radiotherapy preserved Snellen visual acuity of 20/50-2 (≈0.44 logMAR) in the affected eye, although systemic disease progressed four months later. This case highlights the importance of meticulous fundus examination, multimodal imaging, and molecular profiling for distinguishing metastatic choroidal melanoma from primary uveal melanoma when ocular inflammation obscures malignancy, thereby enabling timely, targeted therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".