S2477 Ocular Melanoma: A Rare Complication of TNF-α Antagonist Therapy in Ulcerative Colitis

Introduction: There is a known association between treatment with tumor necrosis factor alpha (TNF-α) inhibitors and melanoma [1]. Despite some reported adverse effects including increased risk of melanoma, TNF-α antagonists have become one of the mainstay therapies in management of ulcerative colitis (UC) [1]. We are going to present a UC patient who developed ocular melanoma while treated with a TNF-α inhibitor to bring more attention to this rare complication and encourage routine screening for UC patients on a TNF-α antagonist. Case Description/Methods: 71-year-old male with UC, was being treated with infliximab since 2000. He had a history of recurrent retinal detachments in the right eye. Multiple attempts to correct the retinal detachments have failed, which led to phthisis of the patient’s eye by 2018. He lost vision and developed pain in his right eye. He underwent enucleation in November of 2020 with the histology consistent with ocular melanoma. Pathology indicated epithelioid morphology with extrascleral extension of 2.5 cm. Subsequent work up revealed right upper lung metastases. Pt underwent right upper lobe resection. The metastasis measured 1.5 cm. Due to poor local control, patient had to undergo repeat surgery with orbital exenteration in February of 2021. The tumor measured 5 cm and extended into the optic nerve and conjunctive. CT scan 2 months later showed 2 lung nodules in left lower lobe suspicious for metastasis. MRI of the orbit from April 2021 demonstrated revealed an enhancing tissue, continuing through the orbital apex, superior orbital fissure and the cavernous sinus, likely due to cancer invasion (Fig. 1). He was referred for proton beam radiation for a local control of the disease. The infliximab was discontinued in 2020 shortly after the diagnosis of melanoma. Discussion: While TNF-α antagonists have been remarkably successful in treating UC, melanoma has become a feared complication [1]. The case illustrated an extremely rare type of melanoma, which likely stemmed from the long-term TNF-α antagonist therapy. Given the aggressive nature of this type of cancer, timely diagnosis is of utmost importance. We hope to bring more attention to screening of UC patients on TNF-α inhibitors to increase the chance of timely detection and survival.Figure 1.: MRI orbits s/p exenteration of the right orbit demonstrating smooth rim of enhancing tissue lining the inner aspect of the bony orbit. This homogenous tissue continues through the orbital apex, superior orbital fissure, and extends into the right cavernous sinus, likely signifying melanoma invasion and unlikely radiation fibrosis.