Answer
Observation may be acceptable for posterior uveal tumors where diagnosis is not well established. In particular, tumors of less than 2-2.5 mm in elevation and 10 mm in diameter can be observed until growth is documented. Photography (see the image below) and sequential ultrasonography for precise measuring of the tumor’s dimensions are usually necessary.
Choice of treatment of choroidal melanoma remains controversial in many respects. Although enucleation has been the treatment of choice in the past, it appears that vision-sparing approaches might offer similar degrees of ocular and metastatic tumor control—particularly because it is clear that in many patients at the time of diagnosis, posterior uveal melanomas already have spread through micrometastasis.
-
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.
