Which findings on ophthalmologic exam are characteristic of choroidal melanoma reveal?

Updated: Feb 18, 2020
  • Author: Enrique Garcia-Valenzuela, MD, PhD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Ophthalmologic examination may reveal the following:

  • Small choroidal melanomas typically take the form of a nodular, dome-shaped, and well-circumscribed mass under the retinal pigment epithelium

  • As choroidal melanomas grow, they may adopt more irregular configurations (eg, bilobular, multilobular, or mushroom shapes)

  • Diffuse choroidal melanoma, characterized by lateral growth throughout the choroid with minimal elevation, are more difficult to diagnose and often cause significant exudative retinal detachment [1]

  • Choroidal melanomas may have variable coloration, ranging from amelanotic to darkly pigmented; some are partially pigmented

  • If the tumor is light-colored, its abnormal vascularization usually can be seen ophthalmoscopically

  • Overlying the choroidal melanoma, there are usually retinal pigment epithelial changes (eg, drusen), patches of atrophy, and orange discoloration; orange changes can occur in both malignant and benign lesions

  • Choroidal melanoma may remain undetected underneath a large exudative retinal detachment, a subretinal hemorrhage, or a vitreous hemorrhage

  • Infrequent presentations of advanced choroidal melanoma are a painful blind eye with cataract and proptosis from tumor transscleral orbital extension

  • Anterior choroidal melanomas might show sentinel vessels (dilated episcleral blood vessels visible through the conjunctiva) that feed the metabolically active tumor

  • Transscleral growth of an anterior choroidal melanoma (mainly through emissary channels) may appear on examination as a small subconjunctival area of abnormal hyperpigmentation

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