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A 66 y/o white female was referred by her local Optometrist for suspicious choroidal lesion. Pt is asymptomatic, VA is good.

A non-pigmented elevated lesion is seen on fundus exam.

OCT did not show subretinal fluid.

No orange pigments on FAF.

B-scan shows low internal reflectivity, significant vascularization (“flickering sign” only visible by dynamic B-scan exam and seen as a pulsatile movement), and a thickness of 2.6mm.

A Fine Needle Aspiration Biopsy was performed and was consistent with a Melanoma, the Genetic Expression Profile was Class 1A, PRAME Negative.

What does this biopsy result mean???

There are 3 different genetic profiles in Melanomas:

Class 1A: Least aggressive and Lowest risk of metastasis,2% 5-year death rate.

Class 1B: Higher risk of metastasis, 28% 5-year death rate.

Class 2: Most aggressive and highest risk of metastasis, 72% 5-year death rate.

PRAME is an antigen overexpressed in melanoma and is a sign of a higher risk of metastasis and poorer outcome if present.

Our patient had the best prognostic option possible.

She will undergo plaque radiotherapy.

Stephane Fitoussi
Stéphane Fitoussi, OD is originally from Paris, France and earned his Bachelor of Optometry in Israel. He achieved his Doctorate of Optometry at Nova Southeastern University in Florida and his residency in Ocular disease at the Bascom Palmer Eye Institute in Miami. He is the creator and manager of Interesting Retinal Cases where retinal content is posted through interesting educational images and real-life cases.

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