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

A 47-year-old white man was referred for a pigmented fundus lesion.  There is a family history of prostrate cancer in father and carcinoma of the esophagus in grandfather.  Visual acuity was 6/6 in both eyes and anterior segment examination was within normal limits.  Fundus examination was normal in left eye.  Right eye fundus examination (Fig. 1) and ultrasonography (Fig. 2) confirmed a pigmented lesion 8.5 x 8.5 x 2.0 mm in size.

1.	What is the most probable diagnosis?
	a. choroidal nevus b. choroidal melanoma c. choroidal hypertrophy of retinal pigment epithelium (CHRPE) d.  retinal pigment epithelium (RPE) adenoma
2.	What are the risk factors for the disease to be malignant?
	a. size and thickness b. margin of tumor c. none of the above d.  all of the above
3.	How would you manage the patient?
	a. plaque radiotherapy b. observation and regular follow up c. transpupillary thermotherapy d.  enucleation

For answers to the above, click here on or after March 25, 2008.