A 58-year-old female patient was referred to the Wills Eye Hospital Ocular Oncology Service for evaluation of a pigmented choroidal mass in the right eye. Visual acuity was 20/25 OU. Anterior-segment examination revealed multifocal iris nevi in the right eye, distinct from freckles by their elevation and stromal integration, spanning 8 clock hours (Figure, A). Fundus ophthalmoscopy demonstrated pigmented choroidal melanoma with ciliary body extension in the right eye (Figure, B). Gonioscopy revealed no seeding into the anterior chamber angle, but the lesion was 3.5 mm in thickness by ultrasonography. Findings were consistent with ciliochoroidal melanoma with multiple iris nevi in the right eye. Risk factors for uveal melanoma include fair complexion, light iris color, oculodermal melanocytosis, and a BAP1 germline gene variant.1 Although only 2% of iris nevi tend to transform into melanoma, the risk for ocular melanoma increases linearly with each additional nevus.2,3 Compared with eyes without iris nevi, eyes with 4 or more nevi have 2.6-fold increased odds for ocular melanoma.3 Eyes with iris nevi require annual examination.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Carol L. Shields, MD, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut St, 14th Floor, Ste 1440, Philadelphia, PA 19107 (email@example.com).
Conflict of Interest Disclosures: Dr Shields reported receiving financial support from the Eye Tumor Research Foundation. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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