New pigmented lesion over a site of tumor treatment.

Awoman in her 70swas referred for treatment of a choroidal melanoma of the left eye approximately 4 years ago. At presentation, she reportedoccasionalphotopsias, floaters, andblurredvisionbutnopain. Visual acuity was 20/25 OD and 20/40 OS.Herchoroidalmelanomawas locatedat the 11to 1-o’clock position, anterior to the equator but posterior to the ciliary body. Low internal reflectivity andamassmeasuring8.4mminheightby 12.9 mm across the base (Figure, A and B) were revealed on B-scan ultrasonography. A complete blood cell count and results of liver function testswerewithin reference limits; a computed tomographic scanof the abdomen, chest, brain, and orbits showed no evidence ofmetastasis. A radioactiveepiscleral iodine 125 (I) plaquewassurgicallyplaced overthe lesionandremoved1week later.Thetumordecreased inheight, and visual acuity remained stable at 20/30 OS. The tumor height decreased to 2.3mmby 1 year and remained at less than 2mm in years 2 through 41⁄2 on B-scan ultrasonography (Figure, B). At her last follow-up, the patient had a 4.5 × 3.0-mm bluish black flat lesion on the sclera (Figure, C). Results of a dilated fundus examinationshowedagrayishblack,minimallyelevatedchoroidal lesionwith surrounding retinal pigment epithelial atrophy butwithout subretinal fluid, hemorrhage, or hard exudates. Quiz at jamaophthalmology.com T12 • 1.38 mm A B C Slitlamp Photograph B-Scan Ultrasonography