🔷Optic Disk Melanocytoma🔷
🔶Intraocular Tumors🔶
👁 / @visualsystem
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🟢 Optic Disk Melanocytoma (ODM) is a rare benign pigmented neoplasm, which seldom exhibits malignant transformation; nevertheless it can show growth and several complications. It is necessary to differentiate it from other neoplasms such as choroidal melanoma and choroidal nevus.
🟢 Melanocytoma has a benign course and is derived from uveal melanocytes, such as uveal nevi and malignant melanoma. It may occur anywhere in the uvea and the pathogenesis is unknown, but it is generally assumed to be a congenital lesion.
🟢 It is usually unilateral, but in children may be bilateral. Clinically, the ODM appears as a pigmented homogeneous mass with total absence of autofluorescence.
🟢 It can be confined to the disk in 15% of cases. Approximately 50% of melanocytomas involve one quadrant of the optic disk with the inferotemporal quadrant being the most common site (33%) and the nasal side being the least common (12%). Melanocytoma can extend over the margin of the optic nerve head to involve the adjacent choroid in 54% of patients or the adjacent retina in 30%. Commonly remains stable with only rare instances of malignant transformation. In some cases, it can progressively grow, which may lead to vitreous seeding and neovascularization.
🟢 ODM are generally stable, but 10-15% of them show enlargement over several years. The main predictive risk factor for growth is an initial thickness greater than 1.5 mm. Larger lesions may develop tumor necrosis, ischemic optic neuropathy, or retinal vein obstruction. Malignant transformation is estimated to occur in about 1-2% of patients. Features of malignant transformation include extensive involvement of the optic disk with severe visual loss.
🟢 ODM can show ischemic necrosis, disk edema (25%), intraretinal edema (16%), subretinal fluid (14%), yellow intraretinal exudation (12%), focal hemorrhage (5%), vitreous seeds (4%), and retinal vein obstruction (3%).
🟢 Differential diagnosis: malignant melanoma, choroidal nevus, optic nerve glioma, capillary hemangioma or metastases.
🟢 This lesion does not require any type of treatment.
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📚Text references: eyewiki.aao.or...
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👤 J.R. Fontenla, MD-PhD.
Medical Consultant in Ophthalmology
🏨 Hospital Clinic of Barcelona
Professor of Ophthalmology
🏛 University of Barcelona
📩 visus.formacion@gmail.com
🌍 Instagram: @visus.formacion
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15 окт 2024
