Photo Quiz

Asymptomatic Hyperpigmented Iris Lesion


Am Fam Physician. 2018 Jul 1;98(1):47-48.

A fair-skinned seven-year-old girl presented to her physician because her parents were concerned about a lazy eye. She had no eye trauma, pain, or vision changes.

Physical examination revealed an asymmetric, hyperpigmented lesion that was isolated to the iris of her left eye (Figure 1) and was not present the year before. The examination was otherwise normal.

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Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Iris freckle.

B. Iris melanoma.

C. Iris nevus.

D. Primary iris stromal cyst.


The answer is B: iris melanoma. Iris melanomas are a type of uveal melanoma. They are uncommon and account for approximately 5% of uveal melanomas.1 The lesions are asymptomatic and typically identified during a routine examination with a primary care physician. Iris melanomas are the most common primary malignancy of the iris.2 The mean age of presentation is 40 years. There is no predilection for sex, but they are more common in persons with fair complexions. Iris melanomas can be circumscribed or diffuse. Circumscribed melanomas arise in the inferior iris in approximately 80% of cases. Iris melanomas are unilateral and most are shades of brown, although they may also be yellow or tan.1,2

Using an ophthalmic microscope, an ophthalmologist can definitively diagnose an iris melanoma by identifying prominent

Author disclosure: No relevant financial affiliations.

Address correspondence to Matthew Hawks, MD, at Reprints are not available from the authors.

The opinions expressed in this article do not represent the official opinions of the US. Air Force or the Department of Defense.


show all references

1. Rennie IG. Don't it make my blue eyes brown: heterochromia and other abnormalities of the iris. Eye (London). 2012;26(1):29–50....

2. Henderson E, Margo C. Iris melanoma. Arch Pathol Lab Med. 2008;132(2):268–272.

3. Shields JA, Sanborn GE, Augsburger JJ. The differential diagnosis of malignant melanoma of the iris. A clinical study of 200 patients. Ophthalmology. 1983;90(6):716–720.

4. Shields CL, Shields PW, Manalac J, Jumroendarasame C, Shields JA. Review of cystic and solid tumors of the iris. Oman J Ophthalmol. 2013;6(3):159–164.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

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