8/3/2019 tic Choroidal Melanoma

http://slidepdf.com/reader/full/tic-choroidal-melanoma 1/1

848 www.thelancet.com  Vol 377 March 5, 2011

Clinical Picture

Lancet 2011; 377: 848

Published Online

February 28, 2011

DOI:10.1016/S0140-

6736(10)60815-X

Princess Margaret Hospital,

University of Toronto, Toronto,

Canada (G P Giuliari MD,

A Connor MD, E R Simpson MD)

Correspondence to:

Dr Gian Paolo Giuliari,

Princess Margaret Hospital,

77 Elm Street Apt 903,

Toronto, ON M5G1H4 Canada

gpgiuliari@gmail.com

Amelanotic choroidal melanoma

Gian Paolo Giuliari, Allan Connor, E Rand Simpson

In February, 2010, a 43-year-old woman presented toour clinic complaining of visual floaters in her left eyefor the previous 2 months. She had a history of systemichypertension, but was currently not on medication.Our patient was otherwise healthy. On examination,her visual acuity was 20/20 in each eye. Anteriorsegment examination was unremarkable. Ophthal-moscopy of the left eye showed an amelanotic,vascularised choroidal lesion with a basal diameter of about 9·0×9·5 mm, located at the superotemporalvascular arcade. Vitreous condensations (floaters) were

present in the vitreous cavity (figure A). The lesion

presented a mushroom-shaped configuration that istypically seen when choroidal melanomas grow andcause rupture of the Bruch’s membrane (figure B),which is the innermost layer of the choroid. Fluoresceinretinal angiography revealed the characteristic doublecirculation within the lesion (figure C). Ultra-sonography showed a lesion thickness of 5·7 mm, amedium to low internal reflectivity and choroidalexcavation (figure D). The patient was diagnosed with achoroidal melanoma and underwent brachytherapywith an iodine-125 plaque.

A B

C D

Figure: Amelanotic choroidal melanoma

(A) Retinal photograph showing 'floaters' in vitreous cavity (arrow) and the posterior aspect of the choroidal lesion (*); (B) amelanotic vascularised choroidal

melanoma with a mushroom configuration secondary to rupture of Bruch's membrane (arrows); (C) fluorescein retinal angiography showing lesion with double

circulation (arrow); (D) ultrasonography showing a choroidal lesion with low reflectivity and choroidal excavation (5·7 mm thickness).