Which clinical history findings are characteristic of choroidal melanoma?

Updated: Dec 12, 2018
  • Author: Enrique Garcia-Valenzuela, MD, PhD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

Choroidal melanomas remain asymptomatic for prolonged periods of time; they may be found incidentally during ophthalmoscopy. In general, the more anterior their origin, the longer the delay of any symptoms. Choroidal melanoma may present with the following symptoms:

  • Blurred visual acuity consequent to various mechanisms, including growth of the melanoma into the subfoveal retina, cystoid macular edema, retinal detachment, vitreous hemorrhage, cataract, and blockage of the visual axis directly by the tumor

  • Paracentral scotoma, occurring as the tumor affects the perifoveal retina

  • Painless and progressive visual field loss, occurring as peripheral melanoma grows or exudates subretinal fluid

  • Floaters, developing when areas of necrosis within the tumor or adjacent structures produce vitreous hemorrhage or hyphema

  • Severe ocular pain, occasionally occurring secondary to impingement of choroidal melanomas on posterior ciliary nerves or to high intraocular pressure from acute angle-closure glaucoma

  • History of weight loss, marked fatigue, cough, or change in bowel or bladder habits, which should prompt consideration of primary nonocular malignancy with choroidal metastasis


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