A patient presented with a dark-brown tumor and melanotic vitreous cells in the amblyopic right eye (OD) (Figure A). OCT revealed a sonolucent optic disc tumor (Figure B). Differentials for this finding included metastatic cutaneous melanoma, necrotic uveal melanoma, and melanocytoma with vitreous seeding^(1,2). A vitrectomy confirmed the diagnosis of a melanocytoma with low metastatic risk (Class 1, PRAME-negative) and an excellent outcome^(1,3) (Figures C and D). Optic disc melanocytomas occasionally enlarge, causing visual loss due to spontaneous tumor necrosis or compressive neuropathy^(1,4). Malignant transformation occurs in 1%-2% of the lesions⁽⁵⁾.

ACKNOWLEDGMENTS

This work was supported by funds from the Sylvester Comprehensive Cancer Center (Z.M.C), Bascom Palmer Eye Institute received funding from National Eye Institute Grant P30 EY014801 and Research to Prevent Blindness Unrestricted Grant GR004596-1.

GRG is supported by CAPES scholarship (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), Brazil.

REFERENCES

1. Lauritzen K, Augsburger JJ, Timmes J. Vitreous seeding associated with melanocytoma of the optic disc. Retina. 1990;10(1):60-2.

2. Ashkenazy N, Harbour JW, Dubovy SR, Albini TA, Sridhar J, Patel N, et al. Vitreous metastasis from cutaneous melanoma: diagnosis and management. Arq Bras Oftalmol. 2023;87(5):e20220215.

3. Harbour JW, Correa ZM, Schefler AC, Mruthyunjaya P, Materin MA, Aaberg TA Jr, et al. 15-Gene expression profile and PRAME as integrated prognostic test for uveal melanoma: first report of collaborative ocular oncology group study no. 2 (COOG2.1). J Clin Oncol. 2024;42(28):3319-29.

4. Guo H, Li Y, Chen Z, Guo X. Vitreous seeding from a large optic disc melanocytoma. J Neuroophthalmol. 2014;34(3):276-7.

5. Apple DJ, Craythorn JM, Reidy JJ, Steinmetz RL, Brady SE, Bohart WA. Malignant transformation of an optic nerve melanocytoma. Can J Ophthalmol. 1984;19(7):320-5.

Informed consent was obtained from the patient included in this study.

Conflicts of interest: Dr. Correa is an investigator for Castle Biosciences, Inc. and Ideaya Biosciences, Inc. No conflicts for the other authors.

Informed consent was obtained from the patient included in this study.