title: De novo Evolution of a Small Choroidal Melanoma.
abstract: OBJECTIVE
  To report the evolution of a de novo choroidal melanoma.
  
  
  METHODS
  This is a case report of a 22-year-old white male patient who has been undergoing periodic examination for a choroidal 'freckle' since 10 years of age.
  
  
  RESULTS
  In 2007, a fundus photograph of the left eye showed a nondescript area of choroidal hyperpigmentation temporal to the fovea. Progressive growth was observed and, by 2012, the lesion had become well circumscribed and raised. One year later, a 4.5 × 4.5 × 1.5 mm, dome-shaped, pigmented, choroidal mass with subretinal fluid and orange pigmentation was evident. The lesion was classified as a small choroidal melanoma. Six months after plaque radiotherapy, tumor regression with total resolution of the subretinal fluid was documented.
  
  
  CONCLUSIONS
  The distinction between small choroidal melanoma and choroidal nevus is not absolute; therefore, some choroidal melanomas may initially be mislabeled as choroidal nevi because of their small size until continued growth identifies them to be small choroidal melanomas. In our case, the documented growth of the choroidal lesion on each consecutive visit and its high-risk features strongly suggest that it had been a melanoma from the beginning. To our knowledge, this is only the second documented case of a de novo evolution of a small choroidal melanoma.
authors.affiliation: Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Nino
authors.initials: N
authors.lastname: Aleksidze
authors.affiliation: Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Medina
authors.affiliation: Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Arun D
authors.initials: AD
authors.lastname: Singh
keywords: Choroidal neoplasms; De novo choroidal melanoma; Evolution; Small choroidal melanoma