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JAMA Ophthalmology Clinical Challenge
March 2016

Enlarging Multiple Neoplastic Skin Growths

Author Affiliations
  • 1Department of Ophthalmology, University of Illinois at Chicago College of Medicine
JAMA Ophthalmol. 2016;134(3):337-338. doi:10.1001/jamaophthalmol.2015.3600

A 31-year-old white man was referred for treatment for multiple bilateral neoplastic growths present for more than 20 years. Over the last 5 years, these lesions greatly increased in size and number, with the most substantial growth in the last year. At presentation, he denied any biopsies of the lesion or family history of similar lesions. He was otherwise healthy except for a history of multiple cysts removed from the gums during a dental procedure many years prior.

Visual acuity was 20/50 OD and 20/25 OS, with full extraocular movements. On examination, there were multiple pigmented lesions as well as nodules with central ulcerations on both lower eyelids (Figure, A). There was foreshortening of the inferior fornix as well as cicatricial/mechanical ectropion (right eye > left eye). The eyelid margin and lateral canthi were obliterated secondary to the lesions in each eye. The corneas were clear and the conjunctiva was white and quiet in each eye. The iris had multiple iris nevi in each eye. On posterior examination, there was a thick epiretinal membrane with lamellar hole in the right eye and normal posterior examination in the left eye.

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