A 66 y/o white female was referred by her local Optometrist for suspicious choroidal lesion. Pt is asymptomatic, VA is good.

A non-pigmented elevated lesion is seen on fundus exam.

OCT did not show subretinal fluid.

No orange pigments on FAF.

B-scan shows low internal reflectivity, significant vascularization (“flickering sign” only visible by dynamic B-scan exam and seen as a pulsatile movement), and a thickness of 2.6mm.

A Fine Needle Aspiration Biopsy was performed and was consistent with a Melanoma, the Genetic Expression Profile was Class 1A, PRAME Negative.

What does this biopsy result mean???

There are 3 different genetic profiles in Melanomas:

Class 1A: Least aggressive and Lowest risk of metastasis,2% 5-year death rate.

Class 1B: Higher risk of metastasis, 28% 5-year death rate.

Class 2: Most aggressive and highest risk of metastasis, 72% 5-year death rate.

PRAME is an antigen overexpressed in melanoma and is a sign of a higher risk of metastasis and poorer outcome if present.

Our patient had the best prognostic option possible.

She will undergo plaque radiotherapy.