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ONE MINUTE OPHTHALMOLOGY
Year : 2018  |  Volume : 66  |  Issue : 6  |  Page : 745

Transformation of nevus to melanoma, or not?


Wills Eye Hospital, Philadelphia, USA

Date of Web Publication22-May-2018

Correspondence Address:
Carol L Shields
Wills Ocular Oncology Services, Wills Eye Hospital, 840 Walnut Street, Philadelphia 19107, PA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_540_18

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How to cite this article:
Yu MD, Shields CL. Transformation of nevus to melanoma, or not?. Indian J Ophthalmol 2018;66:745

How to cite this URL:
Yu MD, Shields CL. Transformation of nevus to melanoma, or not?. Indian J Ophthalmol [serial online] 2018 [cited 2018 Jun 19];66:745. Available from: http://www.ijo.in/text.asp?2018/66/6/745/232846



A 51-year-old Caucasian woman with history of stable submacular choroidal nevus in the right eye (OD) noted blurred vision for 3 weeks. Visual acuity was 20/200 OD and 20/50 in the left eye. Both eyes showed mild cataract. Funduscopy revealed a stable pigmented choroidal nevus OD, but with new development of subretinal hemorrhage and shallow overlying fluid, extending into the foveola. The mass appeared hypoautofluorescent centrally, with hyperautofluorescence in the subretinal fluid (SRF). Fluorescein angiography (FA) showed pinpoint leakage most intense along the inferonasal margin, suggestive of choroidal neovascularization membrane (CNVM).


  What Is Your Next Step? Top


  1. Initiate plaque radiotherapy
  2. Perform photodynamic therapy (PDT) with verteporfin
  3. Perform intravitreal antivascular endothelial growth factor (VEGF) injection
  4. Observe the lesion for 3 months [Figure 1].





  Findings Top


Fundus photography (A) documented the elevated choroidal lesion along the inferotemporal parafoveal region. The lesion was echodense and measured 1.5 mm in thickness by B-scan ultrasonography. On late-phase FA (B), diffuse hyperfluorescence was seen overlying the mass, representing SRF and most intense near the foveola, suggestive of CNVM. Optical coherence tomography (OCT) (C) confirmed shallow SRF with debris (blood) and retinal pigment epithelial detachment (not shown). OCT angiography (OCTA) (D) depicted a prominent CNVM with a “sea-fan”appearance.

Diagnosis: Choroidal nevus with CNVM and subretinal hemorrhage.

Correct Answer: C.


  Discussion Top


The development of CNVM secondary to choroidal nevus is rare, occurring in <1% of cases.[1] Most choroidal nevi with CNVM are chronic, stable tumors with minimal potential for malignant transformation. However, SRF, orange lipofuscin pigment, and hemorrhage can occasionally represent ominous signs heralding growth into melanoma.[1] The presence of visible CNVM on OCTA and leakage on FA are features supportive of a neovascular, rather than malignant process.[2] The treatment of submacular CNVM overlying choroidal nevus is important for preservation of vision. Chiang et al. demonstrated CNVM response using intravitreal anti-VEGF (bevacizumab), with occasional need for PDT or laser photocoagulation consolidation.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shields CL, Minoru F, Berman EL, Zahler JD, Hoberman DM, Dinh DH, et al. Choroidal nevus transformation into melanoma: Analysis of 2514 consecutive cases. Arch Ophthalmol 2009;127:981-7.  Back to cited text no. 1
    
2.
Pellegrini M, Corvi F, Say EA, Shields CL, Staurenghi G. Optical coherence tomography angiography features of choroidal neovascularization associated with choroidal nevus. Retina 2017. doi: 10.1097/IAE.0000000000001730.  Back to cited text no. 2
    
3.
Chiang A, Bianciotto C, Maguire JI, Park CH, Baker PS, Shields JA, et al. Intravitreal bevacizumab for choroidal neovascularization associated with choroidal nevus. Retina 2012;32:60-7.  Back to cited text no. 3
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