A 32-year-old woman visited our clinic for a routine eye exam. Her BCVA was 20/20 near vision in both eyes. Anterior segment examination was unremarkable. Her right eye showed gray-black pigmentation at the nasal margin of the optic disc extending to the superonasal retina (top left). Fundus of the left eye was normal. A multicolor scan on spectral-domain OCT (Spectralis, Heidelberg) of the right eye showed a greenish-black hue at the nasal and superonasal margin of the disc extending to the superonasal retina (bottom left). A blue reflectance image showed hyperreflectance at the nasal margin of optic disc and adjacent superonasal retina (bottom right). Nasal retinal blood vessels were seen emerging slightly away from the optic disc margin due to their involvement in the substance of an optic disc melanocytoma. The OCT showed a thumblike elevation at the optic disc, which had a hyperreflective border and cast a posterior shadow (top right). The patient was diagnosed with optic disc melanocytoma and advised to attend regular follow-up appointments.

Optic disc melanocytoma is a benign lesion of the optic nerve head that poses little threat to vision and carries low malignancy potential.1-4 Although the color fundus photo showed a black color, the multicolor image detected the superficial nature of the lesion by showing a greenish hue along with the black color. The involvement of the adjacent retina was observed better on the multicolor image, which showed the greenish-black hue extending superonasally onto the retina. The blue reflectance image, which is meant for imaging superficial features, revealed interruptions in the course of vessels at the nasal margin of the disc caused by involvement of vessels in the substance of the optic disc melanocytoma. The multicolor image was more successful at detecting the extent of the tumor compared with the color fundus photo.

1. Shields JA, Demirci H, Mashayekhi A, Eagle RC Jr, Shields CL. Melanocytoma of the optic disk: a review. Surv Ophthalmol. 2006;51(2):93-104.

2. Sharma PM, Sangal K, Malik P, Mathur MB. Malignant transformation of optic disc melanocytoma? a clinical dilemma at presentation with a review of the literature. Ophthalmologica. 2002;216(4):292-295.

3. Urrets-Zavalia JA, Crim N, Esposito E, Correa L, Gonzalez-Castellanos ME, Martinez D. Bevacizumab for the treatment of a complicated posterior melanocytoma. Clin Ophthalmol. 2015;6(9):455-459.

4. Takkar B, Molla K, Venkatesh P. Swept-source optical coherence tomography of an optic disc melanocytoma: the importance of the hyperreflective foci. Indian J Ophthalmol. 2018;66(1):140-142.

To share an image, contact Manish Nagpal, MS, DO, FRCS(UK), at drmanishnagpal@yahoo.com.
Note: Images should be 400 dpi or higher and at least 10 inches wide.