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Ophthalmic Images
July 12, 2018

Amelanotic and Pigmented Uveal Melanoma

Author Affiliations
  • 1Department of Ophthalmology, Centro de Responsabilidade Integrado em Oftalmologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • 2Faculty of Medicine, University of Coimbra, Coimbra, Portugal
JAMA Ophthalmol. 2018;136(7):e181114. doi:10.1001/jamaophthalmol.2018.1114

A 48-year-old white woman presented with a sudden, painless decrease in the vision of her left eye. Her visual acuity was 20/100. Results of an anterior segment evaluation were normal. Fundus examination revealed a bilobed, elevated lesion nasal to the optic disc with an amelanotic portion and a darkly pigmented one (Figure). Ultrasonography revealed a mass consistent with choroidal melanoma with a basal diameter of 17.5 mm and thickness of 7.97 mm. A systemic workup revealed no evidence of metastatic disease. She underwent episcleral brachytherapy with an iodine 125 plaque. Brachytherapy was followed by tumor regression documented by ultrasonography 3 months after the treatment. After the first year, she maintained the visual acuity noted before treatment, with regression more readily apparent within the amelanotic portion of the lesion.