Just a Freckle?
Igor Westra, MD
Retina of Coastal Carolina
1801 N.H Medical Park Dr.
Wilmington, NC 28403
Time flies! I didn’t realize that I hadn’t seen Mr. K for about five years. He had been seeing me annually for many years because he had a freckle in his left eye. Recently he had noticed a shadow in his vision. I had a sick feeling in the pit of my stomach when the technician told me of his symptoms. I felt even worse when I saw the photos that he had taken of his left retina. I told the technician to go ahead and do an ultrasound of the eye.
Freckles of the retina are quite common. The medical term is “choroidal nevus” and these are composed of the pigmented cells that grow underneath the retina. The vast majority of these freckles are not dangerous but they may grow slightly and can become darker with age. A small minority, however, become malignant and invade the eye and metastasize to other parts of the body to eventually kill the patient. This is called malignant melanoma and treatment is not very successful.
When a nevus is discovered in a patient’s eye, the doctor typically will get photographs and follow the patient on a regular basis, usually getting photographs each time. If there is any suspicious aspect to the nevus, the patient is referred to the retina specialist. I usually recommend follow up every four months when a nevus is first detected and then after a year, annual exams. In addition to photographs, we may do analysis with ultrasound and sometimes with angiography.
My office usually calls patients to remind them of their appointments. Mr. K had moved and his phone number had changed so he never received the call. He knew that he had missed his appointments but felt that after all these years of follow up his lesion must be benign. Unfortunately it was not.
One option for treatment is radiation to the eye using a special holder that is attached to the eye for two to three days. Pre-radiation a biopsy can be done and sent for analysis and prognostic information. Another option is to cut the tumor out from between the layers of the retina. In Mr. K’s situation the tumor was too large and the eye had to be removed. The tissue showed highly invasive cells and the DNA was consistent with cells that were inclined to metastasize. Nine months later tumors were discovered in his liver and six months later he died.
I tell my patients not to lose sleep over the nevus in their eye but make sure that they keep it checked out. Freckles on the skin that can be watched pretty easily and cut off and sent for testing. The choroidal nevus needs specialized equipment to monitor it and cannot be removed without causing eye damage. Fortunately this is a relatively rare cancer and with early detection the prognosis is good.