Answer
Histologic evaluation of the tumor after enucleation can confirm the diagnosis and determine the prognosis (see the images below). [6]
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.
As noted (see Pathophysiology), 3 distinct cell types are recognized to occur in uveal melanomas: (1) spindle A, (2) spindle B, and (3) epithelioid. Spindle A cells have elongated nuclei and uncommonly have mitotic figures (see the image below).
Spindle B cells have a prominent nucleolus (see the image below). They are found more commonly and also have an elongated profile but are slightly larger than spindle A cells.
Choroidal melanoma. Histologic section showing spindle B cells in a uveal melanoma.
Epithelioid melanoma cells are highly anaplastic, poorly cohesive, and have considerable morphologic variation (see the figure below). They tend to resemble epithelial cells and contain frequent mitotic figures.
Choroidal melanoma. Histologic section showing epithelioid cells in a uveal melanoma.
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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.
