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Photo courtesy of: Carol L. Shields, M.D. Used with permission. Not to be reproduced.

A 29-year-old white woman was referred for the management of a freckle in her left eye fundus. There was a history of breast biopsy done in the past which was benign. Best corrected visual acuity was 20/20 in both eyes. Right eye examination was unremarkable. In the left eye, anterior segment examination revealed subtle episcleral pigmentation. On detailed fundus examination, a mass 3.0x2.8x1.6 mm in size was noticed over the infero-temporal edge of otpic disc. There was a modular component, 1.2x1.2x1.6 mm in the center of the main lesion as shown above.

1.	The most likely diagnosis in this case is:
	b -- optic disc melanocytoma
2.	What investigations would you advise for confirmation of the diagnosis?
	a -- fluorescein angiography (FFA)
3.	The treatment is:
	a -- observation and regular follow up

Optic disc melanocytoma is a classical lesion with the following features: Nodular lesion over the disc with feathery margins due to the anatomic arrangement of peri-papillary nerve fibers. The portion of the lesion on the adjacent choroid is less pigmented than the disc component as the overlying retinal pigment epithelium does not allow its dark color to show. Fluorescein angiography (FFA) typically shows hypofluorescence throughout the angiogram, sometimes hyperfluorescence due to disc edema and retinal pigment epithelium (RPE) atrophy. Melanocytoma is unilateral in 99% and undergoes malignant transformation in only 1%-2%, thus needs to be observed annually.