Epipapillary Choroidal Melanoma

ALEX MELAMUD, MD · MICHAEL P. KELLY, CPT · SHARON FEKRAT, MD · PRITHVI MRUTHYUNJAYA, MD

In 1998, a 19-year-old woman had a choroidal nevus near the optic nerve head. Nine years later, when the patient presented for follow-up, the lesion was found to have significantly enlarged. She was referred to the Duke Eye Center Ocular Oncology Clinic, where an elevated, amelanotic, choroidal mass obscuring the entire left optic nerve head was documented by fundus photography. Retinal folds are visualized in the papillomacular bundle region on high-magnification red-free imaging. Spectral-reflectance retinal imaging (640 nm) highlights the borders of the lesion along the nasal edge of the optic nerve at the level of the choroid. Fluorescein angiography identifies the intrinsic retinal vessels within the mass with pinpoint areas of leakage, while B-scan ultrasonography confirms the lesion to be dome-shaped with low internal reflectivity. These findings support the clinical diagnosis of an epipapillary choroidal melanoma. No evidence of metastatic disease was detected on systemic evaluation. This eye was enucleated with placement of an integrated orbital implant. RP

Figure 1. Fifty-degree color fundus photograph of the posterior pole OS, focused on the apex of the lesion.

Figure 2. High-magnification color fundus photograph of the lesion.

Figure 3. Six-hundred forty nm spectral reflectance image better delineating the borders of the lesion.

Figure 4. High-magnification, red-free fundus photograph illustrating the resultant retinal folds.

Figure 5. High-magnification fluorescein angiogram image at 19 seconds post-injection focused on the apex of the lesion and showing its vascularity.

Figure 6. Fifty-degree fluorescein angiogram image at 1 minute post-injection.

Figure 7. High-magnification fluorescein angiogram image 6 minutes post-injection.

Figure 8. Fluorescein angiogram image composite illustrating the extent of the retinal involvement, secondary to the enlarging mass.