This 42YO female presented without complaint. Vision was 20/20 in her normal OD and 20/20 OS. Color fundus photography of the left eye reveals a well-defined, densely pigmented, jet-black lesion arising from the optic disc and extending slightly into the peripapillary retina. On OCT, the elevated lesion is hyperreflective with complete posterior shadowing.
Learning Points:
Melanocytomas are benign melanocytic tumors intrinsic to the optic nerve. They are intensely pigmented with feathery margins, sometimes spreading into the adjacent retina and choroid. A retinal component, as seen in our patient, is found in about 30% of cases (Shields et al, Ophthalmology 2004;111:1739-1746). Although they may enlarge over time, malignant transformation is rare. Spontaneous necrosis may present with a similar appearance to vitreous seeding from melanoma. Vision and visual field loss can rarely occur from compressive optic neuropathy.
