This 44YO presented with these asymptomatic pigmented lesions in his left eye. He is healthy and has no family history of colon cancer.
These lesions most likely represent an atypical case of group-type congenital pigmented nevi of the RPE (bear tracks). This is a relatively rare congenital condition characterized by well-demarcated, hyperpigmented, flat, variably sized RPE lesions resembling bear footprints.
Histopathologically, these lesions are similar to congenital hypertrophy of the RPE (CHRPE), with increased numbers of pigment granules in normal-sized RPE cells. These lesions are benign and cause no visual symptoms.
Learning Points:
Bear tracks should not be mistaken for the comet-shaped lesions in familial adenomatous polyposis (FAP, or Gardner’s syndrome). FAP is an autosomal dominant syndrome associated with colonic polyps and colorectal cancer.
Although typical CHRPE lesions (large, round, unilateral, with depigmented lacunae with age) are not associated with systemic abnormalities, the multifocal, often bilateral, and small comet-shaped lesions with FAP are associated with colonic polyps and cancer (see Romania et al Ophthalmology 1992;99:911-913).
