Figure 1. Ultra-wide field retinal imaging of the right (a) and left (b) eyes. Note pigmented choroidal lesions scattered throughout each eye. SD-OCT (c) shows mild subretinal fluid associated with the elevated lesion in the left eye.
A 68-year-old white female with history of non-small cell lung cancer presented for evaluation of suspicious pigmented masses in both of her eyes. On examination, best-corrected visual acuities were 20/30 OD and 20/50 OS; intraocular pressures were 12mmHg OD and 12mmHg OS. Her anterior segment was unremarkable, with the exception of nuclear sclerotic cataracts OU. Upon dilated fundus evaluation of the right eye, several flat, pigmented, choroidal lesions were found scattered diffusely around the fundus (Figure 1a). Dilated fundus evaluation of the fellow left eye also revealed several pigmented choroidal lesions, as well as an elevated, juxtapapillary pigmented lesion with orange pigment overlying it (Figure1b). Optical coherence tomography (OCT) revealed mild subretinal fluid adjacent to that lesion (Figure 1c). Additionally, ultrasonography of the lesion in the left eye revealed the elevated choroidal mass to have an apical thickness of 1.8mm. All other lesions in both eyes were less than 1.0 mm in apical thickness. The diagnosis of bilateral diffused uveal melanocytic proliferation (BDUMP) was made and the patient was given an anti-VEGF injection of bevacizumab OS to address the leakage adjacent to the elevated lesion in that eye. The patient was currently undergoing chemotherapy and the plan was to continue systemic treatment and return to clinic in four weeks for re-evaluation of the choroidal lesions and retina. Unfortunately, she was lost to follow-up.
Discussion Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic syndrome characterized by diffuse proliferation of benign melanocytes within the uveal tract.1,2 This condition often leads to progressive visual loss via diffuse uveal thickening of pigmented lesions and subsequent serous retinal detachments.2 Diagnosis is based on characteristic clinical and imaging findings, often supported by systemic evidence of malignancy. The pathogenesis of BDUMP is currently poorly understood; however, circulating tumor-derived humoral factors that stimulate melanocytic proliferation have been hypothesized, and an IgG antibody has been identified in some patients.3 BDUMP occurs in association with systemic malignancies, most commonly carcinomas of the ovary, uterus, pancreas, or lung.4,5 Treatment of the condition is primarily directed at the underlying cancer. Ocular therapies, such as intravitreal anti-VEGF therapy and/or photodynamic therapy, target associated subretinal fluid in an attempt to prevent progressive vision loss.6
As advances in oncologic therapies continue to improve survival in patients with metastatic malignancies, ocular paraneoplastic syndromes such as BDUMP may become more frequently recognized. Longer patient survival provides a greater window for paraneoplastic manifestations to develop or be detected. Increased awareness among eye doctors and oncologists is therefore critical for timely diagnosis and appropriate management, including coordination with the treating oncology team.
References
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2. Gass JDM, Gieser RG, Wilkinson CP, et al. Bilateral diffuse uveal melanocytic proliferation in patients with occult carcinoma. Arch Ophthalmol. 1990;108(4):527-533.
3. Miles SL, Niles RM, Pittock S, et al. A factor found in the IgG fraction of serum of patients with paraneoplastic bilateral diffuse uveal melanocytic proliferation causes proliferation of cultured human melanocytes. Retina. 2012 Oct;32(9):1959-66.
4. Klemp K, Kiilgaard JF, Heegaard S, et al. Bilateral diffuse uveal melanocytic proliferation: Case report and literature review. Acta Ophthalmol. 2017;95:439–445.
5. Filho ARG, Godoy R, Medina FMC, et al. Multimodal Imaging Findings in Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP). J Ophthalmic Vis Res. 2025 Oct 22;20:10.18502/jovr.v20.11524.
6. Miyata M, Ooto S, Hata M, Takahashi A, Tsujikawa A. Efficacy of combined anti VEGF and photodynamic therapy for bilateral diffuse uveal melanocytic proliferation: Case series. Medicine (Baltimore) 2021;100:e27578.
