Melanocytic Tumors

Question 1

Most common childhood intraocular tumor? MC adult intraocular tumor? MC primary adult intraocular tumor?

Answer 1

RB, met, choroidal melanoma

Question 2

Virtually all choroidal nevi are less than ____ thick , and virtually all choroidal melanomas are greater than ____ thick.

Answer 2

1 mm; 3 mm

Question 3

malignant risk factors of choroidal melanocytic lesions, in order of most to least significant?

Answer 3

“To find small ocular melanoma using helpful hints daily”
Thickness > 2 mm
Fluid, subretinal
Symptoms (decreased vision, flashes/floaters)
Orange pigment
Margin (w/in 3 mm of disc)
Ultrasound Hollow (low internal reflectivity)
Halo (absence of)
Drusen, LACK OF

Also size > 10 mm diameter

Question 4

signs suggesting malignancy of an iris melanocytic lesion?

Answer 4

ectropion
prominent vascularization
glaucoma
angle seeding
extrascleral extension
sectoral cataract
lesion size
documented progression of growth

Question 5

60 yo white male p/w photopsias 2 weeks. Completely normal slit lamp and scleral depressed exams except a dilated episcleral vessel in superonasal quadrant. What else should you do?

Answer 5

Gonio, to look for ciliary body melanoma

Question 6

single most important ancillary tool to evaluate choroidal melanoma?

Answer 6

ultrasonography

Question 7

ultrasound characteristics of uveal melanoma?

Answer 7

low internal reflectivity

Question 8

multiple CHRPE’s with family history of colon cancer?

Answer 8

Gardner syndrome

Question 9

flat, darkly pigmented chorioretinal lesion with lacunae

Answer 9

CHRPE

Question 10

black epipapillary lesion with fibrillar margins

Answer 10

melanocytoma

Question 11

well-defined, orange-yellow juxtapapillary lesion. CT shows calcifications.

Answer 11

choroidal osteoma

Question 12

prognostic factors for uveal melanoma?

Answer 12

extrascleral extension
size
location (iris best, then choroid, then ciliary body worst)
–also, juxtapapillary location is worse
cell type (spindle best, epithelioid worst)
proliferation
inflammation
genetics: monosomy 3 and trisomy 8 are bad
gene expression profiles
age

Question 13

initial systemic work-up to order when uveal melanoma diagnosed?

Answer 13

CXR, liver imaging, LFTs

Question 14

darkly pigmented, minimally elevated juxtapapillary lesion with tortuous retinal vessels and producing retinal stiae

Answer 14

combined hamartoma of RPE and retina

Question 15

FA characteristics of uveal melanoma?

Answer 15

Double circulation pattern and prominent early choroidal filling