Answer
The differential diagnosis includes the following:
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Choroidal Detachment
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Intraocular Foreign Body
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Chronic Angle Closure Glaucoma
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Glaucoma, Hyphema
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Neovascular Glaucoma
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Cavernous Hemangioma
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Vitreous Hemorrhage
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Hyphema
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Ciliary Body Melanoma
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Conjunctival Melanoma
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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:
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Melanocytic nevus
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Melanocytoma
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Metastatic tumors
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Medulloepithelioma (diktyoma)
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Choroidal osteoma
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Adenoma
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Adenocarcinoma
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Combined hamartoma of the retina and pigment epithelium
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Congenital hypertrophy and reactive hyperplasia of the retinal pigment epithelium
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Retinal cavernous hemangioma
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Presumed acquired retinal hemangioma
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Lymphoid tumor
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Hemangiopericytoma
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Leiomyoma
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Neurofibroma
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Glioneuroma
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Astrocytoma
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Rhabdomyosarcoma
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Posterior uveitis
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Sarcoid nodules
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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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Color photograph of a dome-shaped choroidal melanoma.
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Early fluorescein angiogram of choroidal melanoma showing intrinsic vascularity.
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Late fluorescein angiogram of choroidal melanoma showing early diffuse staining.
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B-scan ultrasound showing acoustic hollowing and uveal excavation in posterior choroidal melanoma.
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A-scan ultrasound of choroidal melanoma showing low-to-medium internal reflectivity.
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B-scan ultrasound showing acoustic hollowing in intraorbital extension of a posterior choroidal melanoma.
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T2-weighted MRI showing a small anterior choroidal melanoma in the left eye.
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Transpupillary photograph showing a posterior choroidal melanoma.
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Photograph showing an enucleated eye with advanced choroidal melanoma with transscleral extension.
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Histologic section of an enucleated eye showing a large dome-shaped choroidal melanoma.
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Histologic section of an enucleated eye showing a medium-sized mushroom-shaped choroidal melanoma with associated exudative retinal detachment.
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Choroidal melanoma. Histologic section showing spindle A cells in a uveal nevus.
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Choroidal melanoma. Histologic section showing spindle B cells in a uveal melanoma.
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Choroidal melanoma. Histologic section showing epithelioid cells in a uveal melanoma.
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Photograph showing a skin metastasis of a posterior choroidal melanoma.
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Intraoperative photograph showing placement of a radioactive plaque for posterior choroidal melanoma.