An Indeterminate Choroidal Melanocytic Lesion: A Case Report

Choroidal nevi are common, benign growths in the eye that are usually harmless but sometimes can present with atypical features, making them challenging to diagnose and distinguish from early-stage melanoma. In this case report, we discuss the case of a 52-year-old male patient with a history of intermittent dryness, blurriness, and floaters in his right eye. Presented to ophthalmology, incidentally revealing a suspected choroidal mass, and we document his subsequent monitoring over a four-year period. Despite the patient developing some risk factors for malignant transformation, such as subretinal fluid, the lesion thickness decreased. Interestingly, the patient's history of gastric sleeve surgery led to a decrease in vitamin B12 levels. This may have played a role in the lesion's behavior, although no direct link to malignancy progression has been established in the literature. This case demonstrates the importance of individualized care, highlighting that not all lesions with worrisome features evolve into melanoma. Close observation and long-term monitoring can be considered an effective strategy, especially in patients without risk factors. This case challenges the standard thinking on choroidal nevi and reinforces the need for personalized management plans, particularly in patients with unusual presentations.