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| CLINICAL IMAGE |
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| Year : 2022 | Volume
: 15
| Issue : 3 | Page : 425-426 |
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Optic Nerve head melanocytoma: Role of multimodal imaging
Sheetal Bajirao Kale1, Priyanka Walvekar2, Virender Sachdeva3
1 Nimmagada Prasad Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
2 Department of Ophthalmic Plastic Surgery, Ocular Oncology, Dacryology and Socket Sciences, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
3 Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
| Date of Submission | 19-Mar-2022 |
| Date of Decision | 23-Jun-2022 |
| Date of Acceptance | 28-Jun-2022 |
| Date of Web Publication | 02-Nov-2022 |
Correspondence Address:
Virender Sachdeva
Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, Nimmagadda Prasad Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam - 530 040, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ojo.ojo_75_22
 Abstract | | |
Keywords: Optic nerve head – melanocytoma (ONH-MCT), melanoma, optic disc tumor, optic-nerve head
How to cite this article:
Kale SB, Walvekar P, Sachdeva V. Optic Nerve head melanocytoma: Role of multimodal imaging. Oman J Ophthalmol 2022;15:425-6 |
“Melanocytoma” is a hamartomatous lesion arising from the melanocytes.[1] Optic nerve head melanocytoma (ONH-MCT) is a rare deeply pigmented dark brown or black benign tumor with feathery margins, overlying or adjacent to the optic nerve head. It may or may not involve the surrounding retina or choroid.[2] ONH-MCT occurs more often in middle-aged women but has no racial predilection. Prior reports suggest that although 32% of cases may increase in the size, only 1%–2% of cases show the malignant transformation. Hence, different investigations such as fundus autofluorescence, B-scan ultrasonography, and optical coherence tomography (OCT) play an important role in confirming the diagnosis and management.[3]
A 44-year-old man presented to our clinic with complaint of mild blurring of vision in the left eye (LE) for 2 weeks. Both eyes examination showed unaided visual acuity of 20/20, normal color vision, round, regular, and reacting pupils, and normal anterior segment. Fundus examination was within normal limits in the right eye (RE) and showed a darkly pigmented dark brown-to-black 1.5-to-2-disc diameter elevated lesion with feathery margins overlying the optic disc in the LE [Figure 1]a. There was no associated orange pigmentation or subretinal fluid around the lesion or any evidence of serous retinal detachment [Figure 1]b. LE OCT depicted a dome-shaped lesion with an anterior hyperreflective margin and shadowing of posterior structures [Figure 1]c B-scan ultrasonography of LE revealed a well-defined iso-echoic elevated lesion at the optic disc with acoustic hollowing [Figure 2]a. Contrast-enhanced axial magnetic resonance imaging of the orbit showed a focal isointense to a slightly hyperintense lesion at the level of the optic nerve head with no intraocular or intraorbital extension.[Figure 2]b. The clinical diagnosis of optic disc melanocytoma was thus confirmed. The patient was advised a monthly follow-up for 3 months and 6 months thereafter for 4 years. | Figure 1: Composite fundus photograph. (a) Right eye. (b) Left eye showing darkly pigmented 1.5–2-disc diameter lesion on the optic nerve head with feathery margins (black arrow). (c) Left eye OCT showed a dome-shaped lesion with anterior hyperreflective margin and shadowing of posterior structures. OCT: Optical coherence tomography
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 | Figure 2: (a) Ultrasound B-scan ultrasonography LE showing a well-defined isoechoic elevated lesion at the optic disc with acoustic hollowing (white arrow). (b) LE orbit contrast-enhanced axial-MRI showing an iso-hyperintensity focal area overlying the posterior aspect of the globe without any extension (white arrow). MRI: Magnetic resonance imaging, LE: Left eye
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It is very crucial to differentiate ONH-MT from other juxtapapillary lesions such as choroidal nevus, adenoma of retinal pigment epithelium, and malignant melanoma accurately as further treatment and prognosis differ.[3] Features which help distinguish among these include margins, color of the lesion, and presence of subretinal fluid. ONH-MCT is darkly pigmented and has irregular margins, but there is the absence of subretinal fluid or orange pigmentation.[4] Our case had features consistent with ONH-MCT, highlighting the role of ocular investigations in establishing the diagnosis.
ONH-MCT needs a regular lifelong follow-up to look for any change in visual acuity, size, shape, and consistency of the lesion. Prior reports suggest an increase in the size of the lesion in 11% of the cases at 5 years and 33% of cases after 10 years of presentation. Only 1%–2% showed the malignant transformation.[3] Further B-scan ultrasonography and OCT are useful to look for tumor growth and signs of malignant transformation (such as an increase in size, vascularity, and nodular change).[5]
The case hereby presented emphasizes the importance of early detection of ONH-MCT and the importance of ancillary investigations for differentiating it from other tumors at the optic disc with a varied management plan.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed
Financial support and sponsorship
This study was financially supported by Hyderabad Eye Research Foundation (HERF), Hyderabad, Telangana, India.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Zimmerman LE. Melanocytes, melanocytic nevi and melanocytomas. Invest Ophthalmol 1965;4:11-41.  |
| 2. | Eldaly H, Eldaly Z. Melanocytoma of the optic nerve head, thirty-month follow-up. Semin Ophthalmol 2015;30:464-9. |
| 3. | Shields JA, Demirci H, Mashayekhi A, Eagle RC Jr., Shields CL. Melanocytoma of the optic disk: A review. Surv Ophthalmol 2006;51:93-104. |
| 4. | Raval V, Reddy R, Kaliki S, Das T, Singh AD. Optic nerve head melanocytoma: Optical coherence tomography/angiography features. Indian J Ophthalmol 2021;69:332-6. [ PUBMED] [Full text] |
| 5. | Gologorsky D, Schefler AC, Ehlies FJ, Raskauskas PA, Pina Y, Williams BK, et al. Clinical imaging and high-resolution ultrasonography in melanocytoma management. Clin Ophthalmol 2010;4:855-9. |
[Figure 1], [Figure 2]
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