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Title	An aggressive small choroidal melanoma or How optic disc swelling helped to suspect extraocular invasion.
Abstract Nr.	1068

Purpose	To describe a small non diffuse choroidal melanoma with extraocular extension.
Methods	A Case-report
Results	We describe the case of a 50year-old patient presenting with visual loss and metamorphopsia. Fundus examination revealed a suprapapillary trilobular choroidal mass with inhomogenous pigmentation and lipofuscin. The optic nerve was slightly oedematous. On fluorescein angiography, the lesion revealed pin-points and exsudation. Ultrasound sonography (20Mhz) showed a peripapillary lesion of 3mm thickness. MRI was performed and confirmed the diagnosis of choroidal melanoma. No extraocular extension was seen on MRI or ultrasound imaging. Because of optic nerve oedema we decided to perform an enucleation. On pathology, the lesion measured 9mm diameter and 3mm thickness. It was mostly composed of epithelioïd cells and it showed scleral, perineural , optic nerve and periocular soft tissue invasion. Complementary orbital radiotherapy was performed. Until now, after one year follow-up, the patient has shown no metastasis or local recurrence.
Conclusion	Extraocular invasion in a small thickness non diffuse choroidal melanoma is rare. In times of eye-sparing choroidal melanoma treatment, the ophthalmologist should not forget the possibility of extra-ocular involvement, even in small tumors.

Authors 1

Last name	LAUWERS
Initials	N.
Department	UZA- Oogheelkunde
City	Edegem

Authors 2

Last name	DE GROOT
Initials	V.
Department	UZA- Oogheelkunde
City	Edegem

Authors 3

Last name	Siozopulou
Initials	V.
Department	UZA- Pathologische anatomie
City	Edegem

Authors 4

Last name	De Keizer
Initials	RJW
Department	UZA- Oogheelkunde
City	Edegem