1. What is the rationale of fundus photograph when in the presentation itself a fundus photograph is given. I agree field test is needed as a follow up.

    CT and MRI MIGHT be helpful in view of facial nerve palsy. ( secondary lesions, in case of malignant melanoma, though the chances are 2 %. Presumption of benign melanocytoma, is ridden with a remote possibility of missing out on the important Differential diagnosis. Avoiding foot in the mouth disease)

    1. The photograph presented with the case represents your view with lens at the slit lamp. Fundus photography is a critical element to this case as the lesion will require following over time for changes.

  2. In experienced hands ultrasound is the first mode of examination. Looking for features suggestive of malignancy.

    Secondly once you have excluded malignancy then you can observe this lesion.

    1. Perhaps… noninvasive, inexpensive and rapid to perform, ultrasound is almost always a nice option for posterior segment masses. However, as discussed in the answer to question number (1), at approximately 1 disc diameter in size, I think that accurately performing USEFUL ultrasound imaging on this lesion overlying the optic nerve head is going to be rather challenging for 99.9% of ophthalmologists. If this were a larger pigmented mass located off of the optic nerve head I would completely agree with you.

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