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SYMPTOMS
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Blurry vision, Metamorphopsia, Scotomas, Peripheral vision loss, Flashes, Floaters, Eye pain
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SIGNS
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Usually isolated (Can be multifocal) | Usually unilateral (Can be bilateral) | Typically found in the posterior pole
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Dome-shaped appearance as it breaks through Bruch’s membrane | Thickness is typically greater than 2mm | Subretinal fluid present with shaggy photoreceptor layer (Over 90% of cases present with SRF)
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Accumulation of leopard skin spots (Macrophages containing lipofuscin and melanin granules) | Large basal diameter (usually greater than 7mm)
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Documented increase in size | Absence of RPE halo and drusen | Typically associated with a serous retinal detachment (90% of the time)
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WORK-UP
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Full eye exam with dilation | OCT | Fundus autofluorescence (Increase in AF due to leopard spots) | Fluorescein angiography (Hypofluorescence due to blockage of dye by tumor cells, followed by mottled hyperfluorescence and subsequent leakage) | ICG (Hypocyanescent without double circulation pattern) | Fundus photos | Infrared photos | B-scan ultrasound (Irregular mass with medium-high internal reflectivity)
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TREATMENT
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Refer to an ocular oncologist/retinal specialist ASAP for treatment (plaque brachytherapy, etc.)
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Refer to PCP/Oncology for additional testing to evaluate and treat cancer elsewhere
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FOLLOW-UP
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Once retina/choroid is stable after treatment with no signs of active melanoma, carefully monitor every 4-6 months (Watch closely for radiation retinopathy)
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ADDITIONAL LAB | TESTS
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CBC with differential | Liver enzyme panel | Renal function Urinalysis | CT or ultrasound of the abdomen and pelvis | CT or ultrasound of the liver | X-ray of the lungs | Mammography | MRI/CT of the orbit
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Testing will most likely be ordered by ocular oncologist
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ETIOLOGY
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Infiltration of the choroid by cancer cells from a primary site through the bloodstream
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DIFFERENTIAL DX
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Choroidal amelanotic melanoma, Choroidal amelanotic nevus, Choroidal hemangioma, Choroidal osteoma, Choroidal granuloma
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NOTES
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Typically associated with breast cancer in females and lung cancer in males
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Patients with a metastatic choroidal tumor have a high mortality rate (100% in 10 years)
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