Forsee Your Next Patient
An 83-year-old woman presented for her annual eye examination. She had a history of previous cataract surgery with pseudophakia and mild dry age-related macular degeneration. She also had a history of a choroidal nevus in her right eye. Close inspection through a dilated pupil revealed no change in the size or shape of the nevus from clinical fundus photographs taken of the same lesion more than 10 years earlier.
A choroidal nevus is a benign pigmented tumor composed of melanocytic cells. These lesions are
typically flat or minimally elevated, variably pigmented, and slate-gray to black in color with overlying yellow drusen on their surface. These drusen are a good indicator of age and inactivity. More rarely, choroidal nevi can be associated with overlying cystic degeneration of the retina, neovascular membranes, subretinal serous fluid, and visual field defects—especially if the nevus is located in the macular area.
The best management of a choroidal nevus is yearly examination through a dilated pupil. The nevi stand out more clearly against the red fundus background with pupillary dilation. Photodocumentation with serial fundus photography is an excellent way to monitor for any growth. If enlargement or elevation of the nevus is noted, then malignant transformation into a choroidal melanoma should be suspected. Choroidal melanomas affect light-skinned persons in the sixth or seventh decades of life and are the most common primary intraocular cancer in adults.
Since this patient’s nevus had not changed in over a decade, she was scheduled for a return ophthalmic evaluation in 1 year. ■