Answer
Irrespective of the treatment modality chosen, patients with choroidal melanomas need to be observed carefully and for many years. This is particularly true for small tumors, when the diagnosis is not established clearly. Close observation and measurement of the dimensions of the tumors with any of the diagnostic tools mentioned earlier is critical.
Repeat examinations usually are performed about every 3 months initially, and if no changes are seen, follow-up care is performed every 6 months. If growth of the lesion is detected, consider further treatment. Choroidal melanomas may show size regression starting several months after being treated with external beam irradiation or plaque brachytherapy. The goal of successful treatment is not necessarily reduction in size but long-term arrest of the tumor’s growth.
Repeat examinations and imaging tests are performed after all treatment modalities because of the possibility of intraocular or extraocular tumor recurrence. Follow-up care in patients with treated choroidal melanomas should include thorough physical examinations, liver function tests, and imaging of lungs, repeated about every 6-12 months. Early detection of distant metastases may affect management and survival.
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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.
