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JAMA Ophthalmology Clinical Challenge
March 2016

A Suspected Choroidal Melanoma With Extraocular Extension in Pregnancy

Author Affiliations
  • 1Moorfields Eye Hospital, London, England
  • 2Ocular Oncology Service, St Bartholomew’s Hospital, London, England
  • 3UCL Institute of Ophthalmology, University College London, London, England
JAMA Ophthalmol. 2016;134(3):339-340. doi:10.1001/jamaophthalmol.2015.3619

A woman in her 20s who was in her first trimester of pregnancy and asymptomatic was referred to the ocular oncology clinic owing to an incidental finding of a suspicious choroidal lesion in the left eye. Ocular and medical histories were unremarkable. On examination, visual acuity was 20/16 in each eye, with normal anterior segments and right fundus. Funduscopy revealed an inferior, variably pigmented choroidal lesion in the left fundus without subretinal fluid or lipofuscin (Figure 1A). B-scan ultrasonography found a solid lesion just posterior to the equator, with low to medium internal echogenicity and with evidence of extraocular spread (Figure 1B). The total elevation was 7.2 mm, and a color-flow map demonstrated internal blood flow. A computed tomographic scan of the orbits showed an isolated intraocular lesion with a subtle degree of extraocular extension into the orbit.

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