Which conditions are included in the differential diagnoses of melanoma?

Answer

The differential diagnosis includes the following:

Choroidal Detachment
Intraocular Foreign Body
Chronic Angle Closure Glaucoma
Glaucoma, Hyphema
Neovascular Glaucoma
Cavernous Hemangioma
Vitreous Hemorrhage
Hyphema
Ciliary Body Melanoma
Conjunctival Melanoma
Iris Melanoma

Benign and malignant tumors, cysts, and other abnormal masses in the choroid, retina, and pigment epithelium must be distinguished from choroidal melanomas. Other problems to be considered include the following:

Melanocytic nevus
Melanocytoma
Metastatic tumors
Medulloepithelioma (diktyoma)
Choroidal osteoma
Adenoma
Adenocarcinoma
Combined hamartoma of the retina and pigment epithelium
Congenital hypertrophy and reactive hyperplasia of the retinal pigment epithelium
Retinal cavernous hemangioma
Presumed acquired retinal hemangioma
Lymphoid tumor
Hemangiopericytoma
Leiomyoma
Neurofibroma
Glioneuroma
Astrocytoma
Rhabdomyosarcoma
Posterior uveitis
Sarcoid nodules
Tubercular granuloma

Other choroidal masses can present with characteristics very similar to those of choroidal melanoma, making it a challenging diagnosis.

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Media Gallery

Color photograph of a dome-shaped choroidal melanoma.
Early fluorescein angiogram of choroidal melanoma showing intrinsic vascularity.
Late fluorescein angiogram of choroidal melanoma showing early diffuse staining.
B-scan ultrasound showing acoustic hollowing and uveal excavation in posterior choroidal melanoma.
A-scan ultrasound of choroidal melanoma showing low-to-medium internal reflectivity.
B-scan ultrasound showing acoustic hollowing in intraorbital extension of a posterior choroidal melanoma.
T2-weighted MRI showing a small anterior choroidal melanoma in the left eye.
Transpupillary photograph showing a posterior choroidal melanoma.
Photograph showing an enucleated eye with advanced choroidal melanoma with transscleral extension.
Histologic section of an enucleated eye showing a large dome-shaped choroidal melanoma.
Histologic section of an enucleated eye showing a medium-sized mushroom-shaped choroidal melanoma with associated exudative retinal detachment.
Choroidal melanoma. Histologic section showing spindle A cells in a uveal nevus.
Choroidal melanoma. Histologic section showing spindle B cells in a uveal melanoma.
Choroidal melanoma. Histologic section showing epithelioid cells in a uveal melanoma.
Photograph showing a skin metastasis of a posterior choroidal melanoma.
Intraoperative photograph showing placement of a radioactive plaque for posterior choroidal melanoma.

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Author

Enrique Garcia-Valenzuela, MD, PhD Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center

Enrique Garcia-Valenzuela, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists, Retina Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Coauthor(s)

Mauricio E Pons, MD Associate Physician, California Retina Associates

Mauricio E Pons, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists

Disclosure: Nothing to disclose.

James E Puklin, MD Professor, Department of Ophthalmology, Chair, Human Investigation Committee, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Cathleen A Davidson, MSc Clinical Staff, Department of Obstetrics and Gynecology, Laboratory of Assisted Reproductive Technologies (ART), University of Michigan Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Additional Contributors

Russell P Jayne, MD Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Retina Specialists

Disclosure: Nothing to disclose.

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