Choroidal Melanoma

Choroidal Melanoma #1 https://www.focuson2020.com/services/comprehensive-eye-exams/
Choroidal Melanoma #1 https://www.focuson2020.com/services/comprehensive-eye-exams/
Choroidal Melanoma
SYMPTOMS Lid tenderness, Blurry vision, Metamorphopsia, Scotomas, Peripheral vision loss, Flashes, Floaters, Eye pains
SIGNS Usually isolated | Usually unilateral Typically gray-green-brown in color. Can be amelanotic
Dome-shaped appearance as it breaks through Bruch’s membrane | Thickness usually greater than 2mm
Subretinal fluid present with shaggy photoreceptor layer | Accumulation of lipofuscin | Lesion within 3mm of the optic disc
Large basal diameter (usually greater than 7mm) | Documented increase in size | Absence of RPE halo and drusen
WORK-UP Full eye exam with dilation | OCT | OCT-Angiography | Fundus autofluorescence (Increase in AF due to lipofuscin) | Fluorescein angiography (Hypofluorescence due to blockage of dye by tumor cells, followed by mottled hyperfluorescence and subsequent leakage. Double circulation pattern could be noted during the arteriovenous phase) | ICG (Hypocyanescent with double circulation pattern) | Fundus photos | Infrared photos | B-scan ultrasound (Solid mass with acoustic hollow area or low internal reflectivity)
TREATMENT Refer to an ocular oncologist/retinal specialist ASAP for treatment (plaque brachytherapy, etc.)
Refer to PCP for additional testing to rule out metastasis
FOLLOW-UP Once retina/choroid is stable after treatment with no signs of active melanoma, carefully monitor every 4-6 months (Watch closely for radiation retinopathy)
ADDITIONAL LAB | TESTS CBC with differential | Liver enzyme panel | CT or ultrasound of the abdomen | CT or ultrasound of the liver (Most common site of choroidal melanoma metastasis is the liver) | X-ray of the lungs | MRI/CT of the orbit
Testing will most likely be ordered by ocular oncologist
ETIOLOGY Malignant neoplasm of melanocytes that may arise from a pre-existing choroidal nevus or arise as a separate lesion
DIFFERENTIAL DX Choroidal nevus, Choroidal metastasis, Choroidal hemangioma, Varix of a vortex vein ampulla
NOTES The majority of uveal tumors are in the choroid (90%)
The median survival rate for a patient with a choroidal melanoma is 7 years
Large melanomas (>8mm thick): 61% chance of metastasis | Medium melanomas (3-8mm thick): 30% chance of metastasis | Small melanomas (<3mm thick): 16% chance of metastasis
“To Find Small Ocular Melanoma Using Helpful Hints Daily” (TFSOM-UHHD)
T: Thickness (>2mm) | F: Fluid (subretinal) | S: Symptoms | O: Orange pigment | M: Margin (within 3mm of the optic disc) | UH: Ultrasonic hollowness | HD: Absence of halo and drusen
(0 risk factors noted: 3% risk of a melanoma, 1 risk factor noted: 38% risk of a melanoma, 3 or more risk factors noted: 50% risk of a melanoma)
Choroidal Melanoma #1 https://www.focuson2020.com/services/comprehensive-eye-exams/
Choroidal Melanoma #1 https://www.focuson2020.com/services/comprehensive-eye-exams/
Choroidal Melanoma #2 Description: B-scan ultrasound demonstrating a choroidal melanoma with characteristic low internal reflectivity' https://eyecancer.com/eye-cancer/image-galleries/ultrasound-images/attachment/16-choroidal-melanoma-dome-shaped-with-retinal-detachment-low-internal-reflectivity-seen-on-interpolated-a-scan-arrow/
Choroidal Melanoma #2 Description: B-scan ultrasound demonstrating a choroidal melanoma with characteristic low internal reflectivity' https://eyecancer.com/eye-cancer/image-galleries/ultrasound-images/attachment/16-choroidal-melanoma-dome-shaped-with-retinal-detachment-low-internal-reflectivity-seen-on-interpolated-a-scan-arrow/
Posted in Choroid, Ocular Conditions