Title

SUSPECT CHOROIDAL MELANOMA LESION – USG FOLLOW-UP CASE REPORT

Introduction

Choroidal nevus are flat/slightly elevated benign lesions with variable pigmentation and clearly defined margins.About 10% of suspect nevus have malign progression.Choroidal melanoma is the most commom primary intraocular malignant tumor in adults and commonly affect people over the age of 55,specialy caucasians.

Methods

Usg follow-up case report of a patient with suspect Choroidal Melanoma lesion.

Results

Female patient,age 66,presented for routine eye check-up in June/2019.Best corrected visual acuity: 20/25; 20/100. Left eye Fundoscopy:slightly elevated macula,measuring about 6 disc diameters.Ultrasonography (USG):cupuliform lesion with smooth surface and acoustically homogeneous interior;A-scan mode shows high inicial amplitude followed by eco pregressive atenuation resulting in Kappa angle.Diagnostic hypothesis:small choroidal melanoma or choroidal nevus.Opted for follow-up with serial USG for measure(Table 1).

Discussion

Differential diagnosis between choroidal nevus and small melanomas can be challenging.They are considered indeterminate lesions when height(thickness measure -TM)exceeds 1mm in USG,and base measure is beyond 5 mm.Recent studies defined manegement based on tumors size and progression.Atipic Nevus(TM 0,5-2mm): observation and reavaluation in 6 months.Small(TM 2-3mm)/non-progressive lesions:Retinography and ultrasound;follow up every 2-3 months.Medium tumors(TM 3-5mm): Local ressection,brachytherapy or enucleation.Large lesions(TM 5-10mm):Brachytherapy or enucleation.Exenteration is restricted for lesions with extensive orbital involvement.Our patient has an indeterminate lesion with Kappa angle,wich is highly sugestive of melanoma.Usg follow-up identified it as a small tumor and no progression has been identified in every two months avaluation,as observed in table 1. Even though it has stable features,it is important to have a systemic screening for metastasys exclusion,specially in lungs and liver,due to melanomas agressive behaviour.

Keywords

Choroidal melanomas; Nevus; indeterminate lesion;

Area

CLINICAL CASE

Authors

Fernanda Salata Antunes, Andréia Novelli, Ever Ernesto Caso Rodriguez, Carolina Maria Barbosa Lemos, Walther de Oliveira Campos Neto, Mariana da Rocha Martini, Anésio Ruiz Neto, Nathália Nishiyama Tondelli