Donor Profile: Steven Finker

When Steven Finker was 15, he discovered a brown spot on the surface of his right eye. Concerned about the condition, he turned to Bascom Palmer for a careful evaluation. “I have had a small spot, like a freckle, in my eye since I was a little kid,” said Finker, who is now 21. “When it started to change shape and color, I wanted to find out what was going on.”

Beginning with his initial visit, CAROL L. KARP, M.D., has monitored Finker’s eye condition, including a recent virtual visit following the COVID-19 outbreak. Using highly magnified photographs and high-resolution optical coherence tomography (OCT), Karp compared images of the brown spot, called a conjunctival nevus, taken at each session, to see if there were any signs it was turning into a dangerous ocular melanoma.

In May, Karp connected with Finker for a follow-up look at his eye. She then advised him to come into Bascom Palmer for a visit. Karp took fresh OCT images of his eyes, and he was able to leave in a few minutes. “I felt very safe during my visit, as all the protective guidelines were followed,” he said.

After reviewing the OCT scans, they discussed the results. “Steven’s brown spot is typical of a benign nevus,” Karp said. “We may continue to monitor the lesion or decide to remove it in the future.”

As professor of ophthalmology, Richard K. Forster Chair in Ophthalmology, and the Dr. Ronald & Alicia Lepke Endowed Professorship in Cornea and Ocular Surface Diseases, Karp has extensive experience in diagnosing and treating pigmented spots, including nevi (freckles), primary acquired melanosis, racial melanosis, pigmented squamous cell carcinoma, and melanomas. “Many of these spots are benign, but if we see changes, we become concerned for possible malignant transformation,” she said.

Karp said a nevus may be present at birth, but without pigmentation, it may not be immediately visible. “Many parents first notice the spot when a child is about age 2 to 5 and the nevus begins to darken,” she said. “Other times, it may change in coloration with hormonal changes, such as puberty or pregnancy.” Individuals with dark skin may have pigmented spots in both eyes, which are usually benign and not a cause for concern.

However, every nevus – which can occur on the eyeball surface or under the eyelid – has a small risk of becoming malignant, she added. “Danger signs include a change in the blood vessels going into the nevus or a change in shape or size or rapid darkening in color. Any new spot that pops up in an adult should be evaluated at once.”

To better diagnose and follow tumors on the eye surface, Karp collaborated with JIANHUA (JAY) WANG, M.D., PH.D., M.S., Bascom Palmer professor of ophthalmology and electrical and computer engineering, to develop Bascom Palmer’s customized anterior OCT imaging system. “It allows us to do an “optical biopsy” of the eye, including any lesions hidden under the eyelid,” she said.

If there is a concern about the nevus, Karp can treat it with a surgical removal, which is combined with a freezing treatment called cryotherapy. In other types of tumors, sometimes topical eye drops that kill cancer cells can be used. “All these therapies are easier when the lesion is small, so it is important to see an eye doctor regularly” she added.

Finker is putting his trust in Bascom Palmer’s expertise in this field. In addition, his family’s private foundation (the Finker-Frenkel Foundation) is supporting the Institute’s research program. “I’ve received great care at Bascom Palmer,” he said. “Dr. Karp is an excellent doctor. She keeps me informed at every step of the way, and I know I’m in good hands.”