Choroidal Melanoma

Question 1

What is choroidal melanoma?

Answer 1

= cancer of melanocytes at choroid (most common intra-ocular tumour in adults)

Question 2

What are the Presentation/Symptoms of choroidal melanoma?

Answer 2

• 6th Decade
• Unilateral
• Can be asymptomatic
• Rare in dark skinned individuals

If symptomatic =

• Decreased Vision
• VF defect (scotoma)
• Floaters
• Balls of light in px’s VF

Question 3

What are the signs of choroidal melanoma?

Answer 3

• Elevated dome shaped mass
• Green/Grey or White (with orange pigment = lipofuscin)
• Indistinct margins
• Irregular shape
• Has its own blood supply
• Scotoma in VF greater than size of lesion

Question 4

What are co-existing features linked with choroidal melanoma?

Answer 4

• Secondary exudative retinal detachment - due to accumulation of Subretinal Fluid
• Secondary Glaucoma
• Cataracts
• Uveitis

Question 5

What are the investigations for choroidal melanoma?

Answer 5

• Fundus Photo
• FFA
• Biopsy
• General Medical Exam
• Transillumination (to distinguish between cyst (bright) or melanoma (dark)
• CT scan

Question 6

What is the management/treatment for choroidal melanoma?

Answer 6

• REFER = ROUTINE OR URGENT (dependant on symptoms and size)

Treatment:

• Radiotherapy (to stop it being aggressive)
• Enucleation (to stop it spreading)
• Chemotherapy

Question 7

How do you distinguish between a melanoma and neavus?

Answer 7

M. argin within 3mm of disc
O. range pigment
U. ltrasound hollow
T. hickness over 2mm
H. alo absent
S. ymptoms
F. luid present
D. rusen absent