Case report of a 45-year-old man with uveal melanoma and suspect controlateral choroidal naevus

Introduction. - Uveal melanoma is the most common adult primary intraoculary tumor. Bilateral tumor is very rare, but must not be underestimated because early diagnosis and care improve the survival and the visual prognosis. Observation. - We report the case of a patient treated for a left parapapillary choroidal melanoma by disk of ruthenium (Ru-106), and a follow-up every 3 months for an atypical choroidal large-sized controlateral naevus levelling the macular area. This right naevus changed in 2009 leading to suspicion of a growing melanoma. Because the visual acuity of the left eye was limited to 20/2000, we wanted to confirm this growth before beginning a treatment. But for 3 years the tumor has remained stable and asymptomatic, with a disease staging still negative. To this day, no curative treatment has been started on the right eye. Discussion. - In spite of clinical (To Find Small Ocular Melanomas (TFSOM) for example) and paraclinical arguments, it is sometimes difficult to differentiate a large naevus from an early melanoma. Evolution of the tumor often allows to confirm the diagnosis. However, the sole growth of a naevus is not specific of a choroidal melanoma. When confronted with suspicion of a small choroidal melanoma, some authors recommend an immediate treatment for the tumor; others prefer to confirm without a doubt a tumoral growth. It is necessary to weigh out the iatrogenic risks of a conservative treatment on the visual acuity in a monophtalm patient on one side, and the vital risk for the patient on the other side, which seems to be limited in case of small-sized melanoma with a slow evolution. Conclusion. - A bilateral choroidal melanoma is rare. Systematic and repeated examinations of both eyes are essential. Management of these complicated cases often leads to discussion. (C) 2012 Elsevier Masson SAS. All rights reserved.