A ten-year follow-up of peripapillary choroidal melanoma

In early stages choroidal peripapillary choroidal melanoma may be confused with a choroidal nevus or melanocytoma. Case report: A 41-year old female was diagnosed having a choroidal nevus in close proximity to the optic nerve head. Unfortunately the patient did not show up for annual review of this lesion. Ten years after the patient was examined for the second time. A massive increase in tumor size and prominence was noted including serous retinal detachment. Medical work up excluded any metastatic growth, and the globe was enucleated. Three years later, the patient is still healthy and there are no signs of metastatic spreading. Histological work up: Heavily pigmented peripapillary choroidal melanoma with fasciculary vasocentric proliferative structure, but no infiltration of the sclera or the lamina cribrosa of the optic nerve. The tumor cells were of midgrade size and some of the nucleoli were slightly enlarged. Mitosis and a syncytial structure were present. Immunohistochemically 5-100 proteins, HMB 45 and NSE were found. The TNM classification was: ICD-O C 69,3; pT2, G1, S0, V0, pNx, pMx, microscopically RO. Conclusion: Pigmented juxtapapillary tumors resembling choroidal nevi require annual surveillance.