Choroidal nevus

Case contributed by Dr Wen Jak Ma

Presentation

Pigmented lesion next to optic disc.

Patient Data

Age: 57
Gender: Female
Modality: Ultrasound

Ovoid hypoechoic uveal nodule leads to mild elevation of the retina. Lesion is immediately on nasal aspect of the optic disc. Lesion has remained stable for a decade. Clinically it is pigmented.

Case Discussion

Clinical and ultrasound findings suggest a choroidal nevus that has remained stable over a decade of follow-up. Annual rate of malignant transformation 1 in 8845. Rate increases with age, and risk reaches 0.78% by 80 years old. 

Risk factors for malignancy on ultrasound include:

  • >2 mm in thickness
  • subretinal fluid
  • margin within 3mm of optic disc
  • sonographic hollowness (rather than solid/fat)
  • no drusen

Risk factors for malignancy on clinical examination:

  • symptomatic
  • orange pigment present
  • absence of halo of depigmentation around lesion
  • absence of drusen

Suspect uveal melanoma if:

  • >2 mm thick and largest basal diameter >7 mm
  • posterior acoustic shadowing
  • spontaneous vascular pulsations
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Case Information

rID: 45484
Case created: 27th May 2016
Last edited: 27th May 2016
System: Head & Neck
Inclusion in quiz mode: Excluded

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