Answer:
The patient had a flat, uniformly pigmented lesion in the left eye with overlying drusen and no growth over three years. There was no subretinal fluid, orange pigment, or abnormal autofluorescence. The presence of drusen and choroidal thickening supports the diagnosis of a large choroidal nevus. Other diagnostic considerations include:
Choroidal melanoma: Typically associated with subretinal fluid and usually lacks overlying drusen. Melanomas generally grow, although some may remain stable for long periods.
Choroidal melanocytoma: These benign lesions are usually darker than nevi, lack overlying drusen, and occur more commonly in more darkly pigmented individuals.
Bilateral Diffuse uveal melanocytic proliferation (BDUMP): A paraneoplastic syndrome in which a non-melanoma malignancy triggers proliferation of uveal melanocytes. It presents with rapidly growing, bilateral, multifocal or diffuse lesions, often with a leopard-spot fundus appearance.
Oculodermal melanocytosis (nevus of Ota):Associated with ocular melanoma, but typically accompanied by scleral and cutaneous hyperpigmentation—features absent in this case.
Recommended management: Periodic monitoring for growth or signs of malignant transformation.
References
Li HK, Shields CL, Mashayekhi A, Randolph JD, Bailey T, Burnbaum J, Shields JA. Giant choroidal nevus: Clinical features and natural course in 322 cases. Ophthalmology. 2010; 117:324–333.
Augsburger JT, Brooks CC, Correa ZM. Isolated choroidal melanocytosis: Clinical update on 37 cases. Graefe’s Arch Clin Exp Ophthalmol. 2020;258:2819–29.
