What is the role of ultrasonography in the workup 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

A-scan ultrasonography of the eye is useful for tumors thicker than 2-3 mm. Choroidal melanoma characteristically shows an initial prominent spike, followed by low-to-medium internal reflectivity with diminishing amplitude and a significant echo (see the image below). Vascular pulsations can be seen as fine oscillations of the internal spiking pattern within the tumor. Standardized ultrasonography has a diagnostic accuracy of more than 95%. Performing sequential A-scans, with accurate dimension measurements, in cases of diagnostic uncertainty is important.

A-scan ultrasound of choroidal melanoma showing lo A-scan ultrasound of choroidal melanoma showing low-to-medium internal reflectivity.

B-scan ultrasonography of the eye is a routine test used in the evaluation of any posterior segment mass. It is especially needed in patients with media opacity. For choroidal melanomas, B-scan ultrasonography is used to help establish the diagnosis, to evaluate possible extraocular extension, to estimate tumor size for periodic observation, and to plan therapeutic intervention.

B-scan ultrasound showing acoustic hollowing and u B-scan ultrasound showing acoustic hollowing and uveal excavation in posterior choroidal melanoma.
B-scan ultrasound showing acoustic hollowing in in B-scan ultrasound showing acoustic hollowing in intraorbital extension of a posterior choroidal melanoma.

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