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Figure 1	Figure 2	Figure 3

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

A 48-year-old white male complained of flashes in center of his right eye field of vision. He was diagnosed elsewhere as having a choroidal nevus and observation was advised. The patient came for a second opinion. The patient’s father had undergone treatment for skin melanoma. On examination, his best corrected visual acuity was 20/40 in right eye and 20/20 in left eye. Anterior segment examination was unremarkable in both eyes. Fundus examination was normal in left eye and the figures below show the fundus picture, fluorescein angiography (FFA) and ocularcoherence tomography (OCT) scan through the tumor [Fig 1, 2, 3]. B scan measured the lesion dimensions as 6mm x6mm x1.6mm.

1.	What is your clinical diagnosis?
	b -- choroidal malignant melanoma
2.	How would you manage this case?
	b -- plaque radiotherapy

Patient was symptomatic and the choroidal lesion had marginal thickness, sub-retinal fluid, and orange pigment on surface and its margins were close to the optic disc. Thus, there were all the risk factors, pointing towards the diagnosis of choroidal malignant melanoma. FFA shows classic mottled hyperfluorescence in vascular filling phases. This lesion, being medium size, could be managed by plaque radiotherapy.

REFERENCES:

1. Shields JA, Shields CL, Donoso LA. Management of posterior uveal melanomas. Surv
Ophthalmol 1991; 36:161-195

2. Shields CL, Shields JA, Clinical features of small choroidal melanoma. Curr Opin
Ophthalmol 2002; 13:135-141