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Answers: 2004 series - July 20, 2004
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Lecture 24 of 50 NEXT»
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A 55-year-old female has noted "flashes" in front of her right eye for three months as well as a "dark spot" in her vision temporally in the right eye. She has 20/20 vision in each eye unaided and is otherwise healthy. A large lesion is present below the disc and macula of the right eye. This lesion is shown on B-scan and an MRI is included. |
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The most likely diagnosis is:
a -- This is most likely a melanoma. This decision can be based on appearance, physical findings, and history. There is no serous detachment seen on B-scan. Coats disease, a condition occurring in younger patients, would have serous detachment. Eales disease is associated with recurrent vitreous hemmorrhage and blurred vision.
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The patient should be followed with:
d -- The prudent course of action for managing a case like this would be to observe the tumor directly at regular, close intervals and at the same time carry out testing to determine if metastases are occurring.
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The following can be said about this patient:
d -- Since this is very likely to be a slow growing melanoma with low potential for metastases enucleation is not a good idea. Instead, observation is the choice. Even a notched plaque would be inappropriate because of the proximity of the tumor to the optic nerve.
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