Case Study 22 Choroidal Melanoma

Abstract

JC is a 60-year-old man who presented to his ophthalmologist with the complaint of recently decreased vision in his right eye. Examination with the ophthalmoscope showed a swollen optic nerve head with some engorgement of the retinal vessels consistent with a central retinal vein occlusion. Echography was performed, and the optic nerve was found to be thickened on A-scan examination with a moderate degree of fluid within the nerve sheath (Fig. 1). The examiner approached the patient systematically and scanned the opposite eye and incidentally found a peripheral choroidal tumor that was highly consistent with a malignant melanoma (Fig. 2).

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JC is a 60-year-old man who presented to his ophthalmologist with the complaint of recently decreased vision in his right eye. Examination with the ophthalmoscope showed a swollen optic nerve head with some engorgement of the retinal vessels consistent with a central retinal vein occlusion. Echography was performed, and the optic nerve was found to be thickened on A-scan examination with a moderate degree of fluid within the nerve sheath (Fig. 1). The examiner approached the patient systematically and scanned the opposite eye and incidentally found a peripheral choroidal tumor that was highly consistent with a malignant melanoma (Fig. 2).

Fig. 1

Thickened optic nerve (vertical arrows at nerve sheaths)

Fig. 2

A-scan of choroidal melanoma (first vertical arrow at tumor surface and second vertical arrow at sclera)

An accurate differential diagnosis of a pathological process can sometimes be influenced by proper localization.