channels; and (iii) direct extension along or in peripheral nerves. 14 We found no evidence of these processes histologically, aided with immunohistochemical markers for vascular and lymphatic vessels. The inability to identify a structural conduit could reflect the relatively sparse amount of tissue that was available to study surrounding the skin and conjunctival tumours. This case also brings up a relevant issue concerning the risk for regional spread from incisional biopsy of CM. Several studies have addressed this question, but the most definitive answer comes from analysis of the Sunbelt Melanoma Trial. This large, multicentre, randomized, clinical trial involved 2164 patients with CM and found that incomplete excision of primary melanoma (incisional and shave biopsies) did not adversely affect locoregional or distant recurrence as long as appropriate treatment followed diagnostic biopsy. 15 In summary, we describe a patient with CM of temporal skin that caused an ipsilateral conjunctiva melanoma with unusual compartmentalization of malig- nant melanocytes within the epithelium and substantia propria. This pattern of tissue involvement is similar to that described for epidermotropic metastatic melanoma of skin. Although definitive evidence of lymphatic, perivas- cular, or perineural spread was lacking, the proximity of the CM suggests regional rather than blood-borne spread. Andrew R. Carey, Edgar M. Espana, Curtis E. Margo Morsani College of Medicine, University of South Florida, Tampa, Fla. Correspondence to: Curtis E. Margo, MD: cmargo@health.usf.edu REFERENCES 1. 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Kiratli H, Shields CL, Shields JA, De Potter P. Metastatic tumours to the conjunctiva: report of 10 cases. Br J Ophthalmol.. 1996;80:5-8. 8. Kwapiszeski BR, Savitt ML. Conjunctival metastasis from a cuta- neous melanoma as the initial sign of dissemination. Am J Ophthalmol.. 1997;123:266-8. 9. Lees VA, Briggs JC, Effects of initial biopsy procedure on prognosis in stage 1 invasive cutaneous malignant melanoma: review of 1086 patients. Br J Surg. 1991;78:1108-10. 10. Shields JA, Eagle RC Jr, Gausas RE, et al. Retrograde metastasis of cutaneous melanoma to conjunctival lymphatics. Arch Ophthalmol. 2009;127:1222-3. 11. Shields JA, Shields CL, Eagle RC Jr, Raber IM. Conjunctival metastasis as initial sign of disseminated cutaneous melanoma. Ophthalmology. 2004;111:1933-4. 12. Strempel I. Metastatic conjunctival tumor originating in a primary cutaneous malignant melanoma [author’s transl]. Ophthalmologica. 1982;185:52-7. 13. Ziakas NG, Eke T, Kendall CH, Goulstine DB. Metastatic cutaneous melanoma to the conjunctiva in an Afro-Caribbean patient. Eye (Lond). 2000;14:667-8. 14. Van Es SL, Colman M, Thompson JF, et al. Angiotropism is an independent predictor of local recurrences and in-transit metastasis in primary cutaneous melanoma. Am J Surg Pathol. 2008;32: 1396-403. 15. Martin RCG, Scoggins CR, Ross MI, et al. Is incisional biopsy of melanoma harmful? Am J Surg Pathol. 2005;190:913-7. Can J Ophthalmol 2014;49:e97–e99 0008-4182/14/$-see front matter & 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcjo.2014.04.014 Pseudo-Foster Kennedy syndrome due to idiopathic intracranial hypertension Foster Kennedy syndrome is characterized by optic atrophy in one eye and papilledema in the other caused by a frontal lobe mass ipsilateral to the atrophic optic nerve. It was first described by Foster Kennedy in 1911 in a case series of 6 patients with expanding frontal lobe lesions. 1 Foster Kennedy syndrome is thought to be present in 1% to 2.5% of intracranial masses. 2 Optic nerve atrophy with contralateral optic disc edema in the absence of an intracranial mass has been coined pseudo-Foster Kennedy syndrome and is seen most often with nonsimultaneous bilateral nonarteritic anterior ischemic optic neuropathy (NAION). 3 Other causes of pseudo-Foster Kennedy syndrome that have been reported include optic neuritis, trauma, and syphilis. 4 Pseudo- Foster Kennedy syndrome due to idiopathic intracranial hypertension (IIH) is very rare and has been reported only once in the literature. 5 Here, we report an additional case of pseudo-Foster Kennedy syndrome due to IIH. CASE REPORT A 36-year-old overweight female patient (BMI 26.6 m/kg) was referred to the neuro-ophthalmology clinic by an optometrist who incidentally noticed optic disc edema in the right eye and a pale optic disc in the left eye during a routine eye examination. The patient denied blurry vision, transient visual obscurations, diplopia, headache, and tinnitus. She had no notable medical history and denied Correspondence CAN J OPHTHALMOL —VOL. 49, NO. 4, AUGUST 2014 e99