Small malignant melanoma of the choroid with extraocular extension

A disciform macular lesion in the hyperpigmented eye of a patient with melanosis oculi demonstrated slowly progressive increase in size during eight years. Clinical observation and serial fundus photography indicated increase in anteroposterior thickness of the lesion to 2.0 mm and in greatest diameter from 3.5 to 6.0 mm. Subsequent echography revealed an overall anteroposterior dimension of 3.4 mm and an increase to 5.5 mm in 20 months. Enucleation of the affected eye with the intact extraocular tumor mass and a local tenonectomy demonstrated a choroidal malignant melanoma of the epithelioid cell type with extraocular extension, peripapillary scleral infiltration, focal invasion of the juxtalaminar optic nerve, and tumor cells in the subarachnoid space. This experience emphasizes the importance of echography in the periodic evaluation of small choroidal malignant melanomas to detect growth not apparent by ophthalmoscopy.