Letters to the Editor Geographic atrophy and choroidal melanoma located 3 mm apart Asbjorg Geirsdottir, 1 John Hungerford, 2 Einar Stefansson, 1 Fridbert Jonasson, 1 Gudleif Helgadottir 1 and Haraldur Sigurdsson 1 1 Department of Ophthalmology, Lands- pitali University Hospital, Reykjavik, Iceland 2 Ocular Oncology Service, Moorfields Eye Hospital, London, UK doi: 10.1111/j.1600-0420.2007.01128.x Editor, G eographic atrophy (GA) in age- related macular degeneration (AMD) is rare in individuals under the age of 70 years. The prevalence in those aged 60–69 years has been esti- mated to be 1% in the USA (Fried- man et al. 2004) and 1.2% in Iceland (Jonasson et al. 2003). The risk of malignant transformation of a choroi- dal nevus in the White population is low, with an annual incidence in the 60–69-year-old age group of 0.02% (Singh et al. 2005). We report a case of malignant mel- anoma developing from a pigmented lesion, judged to be a choroidal nevus located only 3 mm from an area of GA in a 66-year-old man. At 61 years of age, the subject’s vision deterio- rated rapidly in both eyes over the course of 6 months. Visual acuity (VA) was 6 / 24 OD and 6 / 9 OS. Geo- graphic atrophy was present in both eyes, but was more prominent in the right eye. A choroidal nevus was seen superior to the optic disc (Fig. 1A). With time the atrophic lesions increased in size concurrently with a slow decrease in VA. When the sub- ject reached 64 years of age, fluores- cein angiography confirmed that exudative AMD had developed in his left eye. Two years later, his VA had decreased to 2 / 60 OD and 6 / 60 OS and the atrophic area in his right eye was approximately 3000 lm in diame- ter. However, over the course of < 22 months the pigmented lesion had increased in size and formed a solid homogenous, 2.5-mm thick tumour (Fig. 1B). Features predictive of a developing malignant melanoma include male gen- der, presence of symptoms, increased tumour thickness ‡ 2.0 mm, proximity of tumour to foveola of < 3.0 mm, tumour margin adjacent to the optic disc and the presence of orange pig- ment and subretinal fluid (Shields et al. 2000; Singh et al. 2006). Moreover, tumour growth over a short period is one of the main characteristics of cho- roidal melanoma (Singh et al. 2006). Our patient was male and had appar- ent symptoms and the tumour pos- sessed all the aforementioned features. Therefore, the tumour was considered to be a malignant melanoma of the choroid and was treated as such with a 20-mm notch Ruthenium 106 applica- tor, to a dose of 80 Gy, at a depth of 3.5 mm to include the thickness of the sclera. After the treatment the tumour showed slow, constant regression over the next few years. It is remarkable that in the same fundus, only 3 mm apart, one group of cells undergoes atrophy while another multiplies rapidly. References Friedman DS, O’Colmain BJ, Munoz B et al. (2004): Prevalence of age-related (A) (B) Fig. 1. (A) Geographic atrophy and a choroidal nevus superior to the optic disc can be seen in the subject’s right eye. (B) The pigmented lesion is seen to have formed a solid homogenous, 2.5-mm thick tumour and the atrophic area has increased in size. Acta Ophthalmologica 2008 584