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Ophthalmology

Mucocutaneous Pigmentation in a Patient With Bilateral Diffuse Uveal Melanocytic Proliferation

To identify the key insights or developments described in this article

1 Credit CME

JAMA Ophthalmology

Published Online: August 18, 2022

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Article Information and Disclosures

Mrittika Sen, MD¹;

Andrea Laiton, MD¹;

Carol L. Shields, MD¹

Author Affiliations

¹The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania

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An older adult patient with metastatic cervical cancer noted painless brown pigmentation of the lips with vision loss. The patient developed rapid-onset cataract with visual acuity of hand motions and no fundus view in both eyes. Ultrasonography demonstrated bilateral, multifocal, choroidal thickening. Patchy pigmentation of the lips, palate, and buccal mucosa was noted. After cataract surgery, fundus evaluation revealed multifocal pigmented choroidal lesions, with shallow subretinal fluid, lipofuscin orange pigment, and giraffe skin–like hyperautofluorescence (Figure). These features suggested bilateral diffuse uveal melanocytic proliferation (BDUMP). Sub-Tenon corticosteroid injection was administered bilaterally.

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Article Information

Corresponding Author: Carol L. Shields, MD, Ocular Oncology Service, 840 Walnut St, Ste 1440, Philadelphia, PA 19107 (carolshields@gmail.com).

Conflict of Interest Disclosures: None reported.

Funding/Support: Support provided in part by the Eye Tumor Research Foundation, Philadelphia, Pennsylvania (Dr Shields).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References

Gass JD , Gieser RG , Wilkinson CP , Beahm DE , Pautler SE . Bilateral diffuse uveal melanocytic proliferation in patients with occult carcinoma. Arch Ophthalmol. 1990;108(4):527-533. doi:10.1001/archopht.1990.01070060075053 PubMed Google Scholar Crossref

Pulido JS , Flotte TJ , Raja H , et al. Dermal and conjunctival melanocytic proliferations in diffuse uveal melanocytic proliferation. Eye (Lond). 2013;27(9):1058-1062. doi:10.1038/eye.2013.131 PubMed Google Scholar Crossref

Rahimy E , Sarraf D . Paraneoplastic and nonparaneoplastic retinopathy and optic neuropathy: evaluation and management. Surv Ophthalmol. 2013;58(5):430-458. doi:10.1016/j.survophthal.2012.09.001 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.