Choroidal nevus, choroidal melanoma, congenital hypertrophy of the RPE (CHRPE), reactive hyperplasia of the RPE, RPE adenoma, and RPE adenocarcinoma are among the differential diagnoses that an ophthalmologist considers when evaluating a pigmented lesion in the choroid.
Choroidal nevus is a common and benign condition that typically does not require treatment. However, it is important to monitor the lesion for changes in size, shape, or other features that may indicate malignant transformation into a choroidal melanoma.
Choroidal melanoma is a malignant tumor that arises from the melanocytes in the choroid layer of the eye. It is the most concerning differential diagnosis for a pigmented choroidal lesion. The management of choroidal melanoma typically involves a combination of radiation therapy, surgical resection, or observation, depending on the tumor’s size and location.
Congenital hypertrophy of the RPE (CHRPE) is a benign condition in which the retinal pigment epithelium (RPE) is abnormally pigmented. It usually appears as a flat, round, or oval lesion in the retina and does not require treatment.
Reactive hyperplasia of the RPE is a non-cancerous condition in which the RPE undergoes proliferation in response to an underlying ocular or systemic disease, such as inflammation, infection, or trauma. It typically presents as a localized or diffuse pigmented lesion in the retina and resolves with treatment of the underlying condition.
RPE adenoma is a rare, non-cancerous tumor that arises from the RPE layer of the eye. It can present as a pigmented lesion in the retina and usually does not require treatment, but may need to be monitored for growth or other changes.
RPE adenocarcinoma is a malignant tumor that arises from the RPE layer of the eye and is extremely rare. It typically presents as a pigmented lesion in the retina and requires prompt surgical intervention to prevent metastasis.
In summary, a pigmented lesion in the choroid can have a wide range of differential diagnoses, and an ophthalmologist must carefully evaluate the patient’s medical history, clinical presentation, and imaging findings to arrive at the correct diagnosis and management plan. Early detection and treatment of any concerning features can help prevent serious complications and improve outcomes.