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Last Month’s Blink

Choroidal Nevus With Pigment Epithelial Detachment

Written by Megan S. Steinkerch¬ner, MD, and Arun D. Singh, MD. Photos by Sharon S. Allen, Lisa Jahn-Gregory, OCT-C, and Mark Harrod, CRA, OCT-C. All are at Cleveland Clinic Cole Eye Institute.

A 57-year-old woman presented to the oc­ular oncology service for a lesion noted in the left eye by her local optometrist. The patient reported no recent changes in the vision of either eye. In the left eye, the BCVA was 20/20, and the IOP was 17 mm Hg. Slit-lamp exam of the left eye was largely unremarkable. Fundus exam of the left eye disclosed within the posterior pole a 12 × 10–mm flat pigmented cho­roidal lesion (Fig. 1) with an 8 × 6 × 1.7–mm dome shaped pigment epithelial detachment (PED) with multiple drusen overlying and surrounding the PED. A spectral-domain OCT scan through the area of interest depicted the choroi­dal lesion with an overlying PED and subretinal pigment epithelium drusenoid deposits (Fig. 2). The patient was diagnosed with a choroidal nevus, and repeat examination in six months demonstrated lesion stability.

Due to the COVID-19 pandemic, the patient was lost to follow-up for two years. When she returned, she reported no changes in vision. In her left eye, BCVA was 20/20 and IOP was 13 mm Hg. The choroidal nevus had undergone malignant transformation into a 15.5 × 15 × 6.7–mm choroidal melanoma with an overlying exuda­tive retinal detachment (Fig. 3). The patient received iodine-125 episcleral plaque brachytherapy and transvit­real biopsy of the tumor. The biopsy confirmed malignant melanoma cells, and gene expression profiling of the tissue yielded a result of class 1B. The patient continues to be followed and is responding to plaque brachytherapy.

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