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Last Month’s Blink

Optic Disc Melanocytoma

Written by Susana Henriques, MD, and Inês Coutinho, MD. Photos by Pedro Lino, Orthoptist. All are at Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal.

An asymptomatic 72-year-old woman was referred for evaluation of a melanocytic mass on the optic disc of the left eye to rule out malignancy. On examination, best-corrected visual acuity was 20/25 in both eyes. No remarkable anterior seg­ment findings were present, and theintraocular pressure was normal. Funduscopy showed an elevated brownish-black mass within the optic disc, without peripapillary edema or retinal exudation (Fig. 1). Ultrasonography (US) disclosed a dome-shaped hyperreflective lesion (Fig. 2); spectral-domain (SD) OCT revealed an elevated optic disc, an absent optic cup, and a hyperreflective lesion with deep optical posterior shadowing (Fig. 3); fluorescein angiography (Fig. 4) and OCT angiography (OCTA; Fig. 5) showed super­ficial telangiectatic vessels and intrinsic flow; and fundus autofluorescence demonstrated hypoauto­fluorescence (Fig. 6).

Although optic disc melanocytoma is a benign tumor with a low risk for transforming into mela­noma, vascular complications may occur, leading to visual dysfunction. Multimodal imaging with US and SD-OCT is helpful in detecting and documenting possible malignant transformation or new vision-threatening complications. OCTA can be useful in noninvasively identifying related vascular features such as surface telangiectasias, choroidal neovascularization, or retinal occlusive disease.

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