Case of the Month | February 2022

Case of the Month
February 23, 2022

The Case

The patient was a 71-year-old man referred for evaluation of a fundus lesion in the right eye. The visual acuity was 20/40 OD and 20/20 OS, and he had cataracts in each eye. The fundus examination of the right eye revealed a brown lesion with associated orange pigment and overlying subretinal fluid. He had a dilated fundus examination by a skilled optometrist several years ago, and no such lesion was noted at that time. What is the most likely diagnosis? What treatment, if any, would you recommend?

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.

Case Photos

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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.

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