How is choroidal hemangioma in Sturge-Weber syndrome (SWS) differentiated from choroidal melanoma?

Updated: Dec 26, 2018
  • Author: Masanori Takeoka, MD; Chief Editor: George I Jallo, MD  more...
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Answer

Differential diagnosis of choroidal hemangiomas

When assessing the status of a uveal mass in a patient with Sturge-Weber syndrome, the ophthalmologist must consider the possibility that the lesion may be something other than a choroidal hemangioma.

A major diagnostic difficulty can be separating a hemangioma of the choroid from a choroidal melanoma. A few patients with Sturge-Weber syndrome have developed a choroidal tumor in the eye ipsilateral to the nevus flammeus that eventually proved to be a malignant melanoma rather than a hemangioma. Simultaneous occurrence of uveal melanoma and choroidal hemangioma in a patient with Sturge-Weber syndrome also has been described.

The reddish orange color of choroidal hemangiomas, as viewed with a binocular indirect ophthalmoscope, is an important diagnostic sign that differentiates them from the white or creamy appearance of metastatic carcinomas and amelanotic melanomas. When uveal melanoma is suspected, fluorescein angiography and A-scan and B-scan ultrasonography are essential.


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