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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 56-year-old white woman was noticed to have a dark spot in her left eye with no significant sytemic history. Best corrected vision was 6/6 in both eyes. Right eye examination was unremarkable. Left eye examination revealed a non-pigmented lesion in the anterior chamber angle which measured nearly 5 mm in diameter and contained intrinsic vessels [Fig. 1]. Gonioscopy is shown in Fig. 2 and transillumination showed no shadow in the ciliary body region. Ultrasound showed a lesion measuring 2 mm in thickness and 5 mm in base [Fig. 3]. Fundus examination was normal in both eyes.

1.	What is the most probable diagnosis?
	c -- iris ciliary body melanoma
2.	Risk factors in favor of above lesion to be malignant:
	b -- vessels within the lesion (intrinsic vessels)
3.	The most suitable treatment for this case is:
	c -- partial lamellar sclerouvectomy (PLSU)

This patient had a variably pigmented iris lesion and risk factors for it being a malignant lesion.  These were intrinsic vessels, dilated episcleral vessels, focal cataract and accordion folds in the iris, just in front of the lesion.

Fine needle aspiration biopsy is an option in suspicious cases, but in this case with so many risk factors, PLSU was justified.  Histopathology revealed spindle cell type iris ciliary body melanoma, of amelanotic variant.