Bilateral diffuse uveal melanocytic proliferation presenting as small choroidal melanoma

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Pigmented choroidal lesions require careful differential diagnosis.
• Non-ocular tumors can present with ocular metastases or paraneoplastic syndromes.
• Distinguishing benign lesions from malignancies or other infiltrative processes is critical.

Observation:

• A 70-year-old male with a history of esophageal cancer presented with a pigmented choroidal lesion initially suspected as choroidal nevus.
• The lesion evolved over a year with increased thickness and orange pigment, leading to a diagnosis of unilateral Diffuse Uveal Proliferation.
• Ocular findings progressed despite treatment for esophageal carcinoma recurrence, with similar changes developing in the contralateral eye.

Findings:

• The case highlights the diagnostic challenge of Bilateral Diffuse Uveal Proliferation (BDUMP) mimicking choroidal melanoma.
• A history of non-ocular malignancy, such as esophageal cancer, is a significant factor in the differential diagnosis.
• Progressive visual decline occurred in both eyes, consistent with advanced BDUMP.

Implications:

• BDUMP should be included in the differential diagnosis for any patient presenting with pigmented fundus lesions, especially those with a history of non-ocular tumors.
• Accurate and timely diagnosis of BDUMP is essential for appropriate patient management and can prevent misdiagnosis as choroidal melanoma.
• This case underscores the importance of a comprehensive diagnostic approach integrating clinical presentation, imaging, and patient history.