The patient had a pigmented lesion with associated orange pigment and subretinal fluid. It had a 6 X 5 mm base and 1.1 mm elevation. This lesion had not been noted prior to the recent examination by the referring doctor, despite its location in the superior macula. The patient was diagnosed as having a suspicious nevus, possible melanoma.
Shields and colleagues (1) found that risk factors for growth of a nevus were thickness greater than 2 mm, subretinal fluid on OCT, vision loss, orange pigment, diameter greater than 5 mm, and interior acoustic hollowness on ultrasonography. Risk of growth correlated with the number of risk factors. With our patient having several features associated with tumor growth, treatment versus close observation were discussed with him, and he chose the latter. After five months, there has been no growth of the lesion.
1) Shields CL, Dalvin LA, Ancona-Lezama D, et al. Choroidal nevus imaging features in 3,806 cases and risk factors for transformation into melanoma in 2,355 cases: The 2020 Taylor R. Smith and Victor T. Curtin lecture. Retina 2019;39:1840-1851.