Melanocytoma of the Optic Nerve Head-A Diagnostic Dilemma

Abstract

The clinical features, autofluorescence, B-scan ultrasonography, optical coherence tomography and fluorescein angiography of the lesion were described. Multiple investigation modalities are needed to confirm the benign nature of the lesion. Careful evaluation and follow-up is crucial to avoid misdiagnosis and erroneous management.

Clinical and Spectral-Domain Optical Coherence Tomography Appearance of Optic Disc Melanocytoma: A New Classification and Differentiation from Pigmented Choroidal Lesions

“…The SD-OCT findings of melanoma and nevus we observed were consistent with previous large series [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. The heavily pigmented Type 1 optic disc melanocytoma is usually distinguishable from choroidal melanoma and choroidal nevus by funduscopic findings, but SD-OCT may help confirm the diagnosis and identify associated features, such as subretinal fluid, that could affect the clinical course.…”

“…Though the OCT image of that patient was not shown in their study, this patient could have had shared features consistent with our Type 2 optic disc melanocytoma classification, if higher-quality SD-OCT had been performed. Similarly, a case reported by Zalilawati et al [11] was more lightly pigmented and showed less optical shadowing. We propose that the Type 2 appearance may be the result of fewer signal-blocking pigmented cells within the tumor, resulting in less hyporeflective shadow and more visible intralesional structures.…”

“…These are summarized in Table 3[5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. Our cases corroborate a constellation of findings that have previously been reported and that are typical of most heavily pigmented optic disc melanocytomas: a very prominent and dense optical shadowing by the heavily pigmented tumor; a sharply demarcated interface between the tumor and a thin, hyperreflective layer of the disorganized overlying retina, and hyperreflective dots accumulated at the tumor-retina interface.…”

“…The SD-OCT features of choroidal melanoma and nevus have been well described [1,2,3,4]. While a number of case reports and small case series include limited descriptions of the corresponding features of the classic, darkly pigmented optic disc melanocytoma, these have not included the uncommon, more lightly pigmented form of the tumor [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. We compared the features of both the classic, darkly pigmented and the atypical, more lightly pigmented optic disc melanocytoma with those of pigmented choroidal lesions.…”

Autofluorescence imaging in the differential diagnosis of optic disc melanocytoma

“…; Mohmad et al. ). To our knowledge, this is the first report on the FAF changes caused by this tumour compared with other juxtapapillary pigmented tumours.…”