Focal scleral nodule
D. Observe with no additional testing or intervention
The patient’s history of previous breast and kidney cell carcinomas caused suspicion for choroidal metastasis. Breast carcinoma is the most common primary cancer leading to ocular metastasis, comprising approximately 37% to 53% of metastatic choroidal tumors, often appearing as a unifocal, yellow lesion in a middle-aged woman.1 However, in this case, the OCT showed the lesion completely confined to the sclera, with no choroidal component and causing elevation and thinning of the overlying choroid. Metastasis to the uvea commonly arises within the choroid (90% of cases) because of its rich vascularity, but metastasis to the sclera is exceptionally rare.1- 3 Confirmatory testing with fine-needle aspiration biopsy (choice A) is not required since there is no suspicion for choroidal malignancy. Treatment with plaque radiotherapy (choice B) is not appropriate since this is not a malignant tumor posing risk of growth or metastasis. Initiation of intravitreal methotrexate (choice C) is not appropriate as the lesion is benign and does not represent lymphoma or an inflammatory process.