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Title

Bone metastasis in a case of primary acquired melanosis with atypia

Purpose	Presentation of a patient with Bone metastasis in a case of primary acquired melanosis with atypia.
Methods	In 2008, a 66-year-old female presented herself to her own ophthalmologist with primary acquired melanosis (PAM) with severe atypia at her right eye. In 2009 and in 2012 biopsies were taken from the lesion after which she received treatments with mitomycine 0.5%. In 2014, she was referred to the University Hospital Antwerp for a limbal transplantation (2015 and 2016). In further follow up she had mild PAM over 360° of alternating intensity.
Results	Throughout the follow up she had a cataract and thereafter a retinal detachment for which she underwent a phacovitrectomy on the right eye. During which the PAM was only lightly present on the eye. There was no nodule present nor did the routine check-up of the lymph nodes or nose showed any atypia. On her last follow up in 2019, a metastasis to the spine (Th3) was diagnosed. Both a complete systemic work-up and a pathological examination did not show any melanoma’s in the body.
Conclusion	Metastasis, even as rare as to the bone, from PAM with severe atypia remains a possibility and ophthalmologists need to be alert for this. It is possible these metastases occur due to operations on the affected eye, or by means of a pathological not detected minimal conjunctival melanoma in this atypia.
Conflict of interest	No

Authors 1

Last name	GOEMAERE
Initials	J
Department	University Hospital Antwerp
City	Anwerp

Authors 2

Last name	Lauwers
Initials	N
Department	University Hospital Antwerp
City	Anwerp

Authors 3

Last name	de Keizer
Initials	RJW
Department	University Hospital Antwerp, University of Antwerp
City	Antwerp