Bilateral Diffuse Uveal Melanocytic Proliferation
A rare paraneoplastic disorder affecting the choroid, bilateral diffuse uveal melanocytic proliferation (BDUMP) causes diffuse thickening of the choroid, reddish or brownish choroidal discoloration, serous retinal detachment, and cataracts (Fig 9-18). The bilateral proliferation of benign melanocytes is usually associated with or often heralds systemic cancer. These proliferations can look like large nevi. Most patients with BDUMP also exhibit nummular loss of the RPE, an anatomical change that differs distinctly from large nevi or thickening of the choroid. These areas of RPE loss are hypoautofluorescent during autofluorescence imaging, but hyperfluorescent during fluorescein angiography. OCT shows mounds of residual material, presumed to be persistent RPE cells between areas of loss. Tumors commonly associated with BDUMP are cancers of the ovary, uterus, and lung, but BDUMP may also occur with cancers of the kidney, colon, pancreas, gallbladder, breast, and esophagus.
Figure 9-18 Bilateral diffuse uveal melanocytic proliferation. A, Note the large nevuslike regions of increased pigmentation in this fundus photograph. B, Fluorescein angiography image demonstrates decreased fluorescence in the region of the melanocytic proliferation in the superonasal portion. There is a giraffe-spot pattern to the fluorescence in the posterior pole, secondary to nummular loss of the RPE in the hyperfluorescent areas.
(Courtesy of Mark Johnson, MD.)
Gass JD, Gieser RG, Wilkinson CP, Beahm DE, Pautler SE. Bilateral diffuse uveal melanocytic proliferation in patients with occult carcinoma. Arch Ophthalmol. 1990;108(4):527–533.
Wu S, Slakter JS, Shields JA, Spaide RF. Cancer-associated nummular loss of the pigment epithelium. Am J Ophthalmol. 2005;139(5):933–935.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.