What are the distinctive features of intraocular choroidal melanoma on ultrasound?

Answer

Intraocular melanomas have several distinctive features, as follows:

Low-to-medium reflectivity
Excavation of underlying uveal tissue
Shadowing of subjacent soft tissues
Internal vascularity
An acoustic quiet zone at the base of the tumor called acoustic hollowing

Ultrasound biomicroscopy (UBM) uses high-frequency waves, with excellent resolution for anterior ocular abnormalities. It can differentiate very anterior choroidal melanomas from those of ciliary body origin and can help define the tumor’s anterior border. It is also helpful in assessing angle-closure glaucoma.

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Shields CL, Kaliki S, Furuta M, Shields JA. DIFFUSE VERSUS NONDIFFUSE SMALL (=3 MM THICKNESS) CHOROIDAL MELANOMA: Comparative Analysis in 1,751 Cases. The 2012 F. Phinizy Calhoun Lecture. Retina. 2013 Apr 11. [Medline].
Factors predictive of growth and treatment of small choroidal melanoma: COMS Report No. 5. The Collaborative Ocular Melanoma Study Group. Arch Ophthalmol. 1997 Dec. 115(12):1537-44. [Medline].
Accuracy of diagnosis of choroidal melanomas in the Collaborative Ocular Melanoma Study. COMS report no. 1. Arch Ophthalmol. 1990 Sep. 108(9):1268-73. [Medline].
Prescher G, Bornfeld N, Hirche H, Horsthemke B, Jockel KH, Becher R. Prognostic implications of monosomy 3 in uveal melanoma. Lancet. 1996 May 4. 347(9010):1222-5. [Medline].
Onken MD, Worley LA, Char DH, Augsburger JJ, Correa ZM, Nudleman E, et al. Collaborative Ocular Oncology Group report number 1: prospective validation of a multi-gene prognostic assay in uveal melanoma. Ophthalmology. 2012 Aug. 119 (8):1596-603. [Medline].
Histopathologic characteristics of uveal melanomas in eyes enucleated from the Collaborative Ocular Melanoma Study. COMS report no. 6. Am J Ophthalmol. 1998 Jun. 125(6):745-66. [Medline].
Boggs W. Possible That Early Treatment of Choroidal Melanoma Might Prevent Metastatic Death. Medscape Medical News. Available at http://www.medscape.com/viewarticle/822126. Accessed: March 25, 2014.
Damato BE, Heimann H, Kalirai H, Coupland SE. Age, Survival Predictors, and Metastatic Death in Patients With Choroidal Melanoma: Tentative Evidence of a Therapeutic Effect on Survival. JAMA Ophthalmol. 2014 Mar 13. [Medline].
Callahan MK, Kluger H, Postow MA, Segal NH, Lesokhin A, Atkins MB, et al. Nivolumab Plus Ipilimumab in Patients With Advanced Melanoma: Updated Survival, Response, and Safety Data in a Phase I Dose-Escalation Study. J Clin Oncol. 2018 Feb 1. 36 (4):391-398. [Medline].
Silva IP, Long GV. Systemic therapy in advanced melanoma: integrating targeted therapy and immunotherapy into clinical practice. Curr Opin Oncol. 2017 Nov. 29 (6):484-492. [Medline].
The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma III: local complications and observations following enucleation COMS report no. 11. Am J Ophthalmol. 1998 Sep. 126(3):362-72. [Medline].
The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma II: initial mortality findings. COMS report no. 10. Am J Ophthalmol. 1998 Jun. 125(6):779-96. [Medline].
Ten-year follow-up of fellow eyes of patients enrolled in Collaborative Ocular Melanoma Study randomized trials: COMS report no. 22. Ophthalmology. 2004 May. 111(5):966-76. [Medline].
Detorakis ET, Engstrom RE Jr, Wallace R, Straatsma BR. Iris and anterior chamber angle neovascularization after iodine 125 brachytherapy for uveal melanoma. Ophthalmology. 2005 Mar. 112(3):505-10. [Medline].
Chang MY, McCannel TA. Local treatment failure after globe-conserving therapy for choroidal melanoma. Br J Ophthalmol. 2013 May 3. [Medline].
Phillips C, Pope K, Hornby C, Chesson B, Cramb J, Bressel M. Novel 3D conformal technique for treatment of choroidal melanoma with external beam photon radiotherapy. J Med Imaging Radiat Oncol. 2013 Apr. 57(2):230-6. [Medline].
Caminal JM, Mejia K, Masuet-Aumadell C, Arias L, Piulats JM, Gutierrez C, et al. Endoresection Versus Iodine-125 Plaque Brachytherapy for the Treatment of Choroidal Melanoma. Am J Ophthalmol. 2013 May 13. [Medline].
Mortality in patients with small choroidal melanoma. COMS report no. 4. The Collaborative Ocular Melanoma Study Group. Arch Ophthalmol. 1997 Jul. 115(7):886-93. [Medline].
Boggs W. Palladium-103 radiation effective for small choroidal melanoma. Medscape Medical News. June 25, 2013. [Full Text].
Semenova E, Finger PT. Palladium-103 Radiation Therapy for Small Choroidal Melanoma. Ophthalmology. 2013 Jun 14. [Medline].

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.

of 16

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.

What are the distinctive features of intraocular choroidal melanoma on ultrasound?

Answer

Related Questions:

References

Tables

Contributor Information and Disclosures