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Ophthalmology132 papers

Choroidal melanoma, diffuse

Last edited: 4/14/2026

Overview

Choroidal melanoma is a malignant melanocytic tumor arising from the posterior uvea, posing significant risks to vision and potentially life due to metastatic potential 5.

Diagnosis

  • Clinical Presentation: Varied symptoms including visual disturbances, metamorphopsia, and ocular pain 6.
  • Diagnostic Imaging: B-scan ultrasonography for tumor dimensions and location 3, ICG angiography for better visualization of choroidal structures 28.
  • Differential Diagnosis: Essential to distinguish from simulating lesions such as choroidal hemangioma, varix of vortex vein ampulla, and dislocated intraocular lenses 101124.
  • Biopsy: Fine needle aspiration biopsy can aid in diagnosis 20.
  • Nuclear Medicine: Radioactive phosphorus uptake test used, though limited in differentiating melanomas from metastases 21.

    • Management

  • Primary Treatment:
    • - Stereotactic Radiosurgery: Effective for intermediate-sized tumors with globe and vision preservation 8. - Iodine-125 Plaque Brachytherapy: Directed radiation minimizing damage to normal ocular structures 18. - Enucleation: Reserved for large tumors or those not amenable to conservative treatments 14.
  • Adjunctive Treatments:
    • - Orbital Irradiation: Post-enucleation radiotherapy can improve survival rates 27. - Transpupillary Thermotherapy (TTT): Utilized for selected cases, delivering hyperthermic energy directly to the tumor 9.

    Special Populations

  • Pediatrics: Pediatric choroidal and ciliary body melanomas have a more favorable prognosis compared to adults 4.
  • Elderly: No specific guidelines noted; management tailored to individual health status and tumor characteristics 12.
  • Comorbidities: Management strategies adjusted based on patient comorbidities, emphasizing multidisciplinary care 12.

    • Key Recommendations

  • Utilize B-scan ultrasonography and ICG angiography for accurate diagnosis and monitoring of choroidal melanoma dimensions 328 (Evidence: Strong).
  • Consider stereotactic radiosurgery or iodine-125 plaque brachytherapy as primary treatment options, selecting based on tumor size and location 818 (Evidence: Moderate).
  • Post-enucleation, incorporate orbital irradiation to enhance survival rates 27 (Evidence: Moderate).
  • Provide comprehensive patient education using visual aids to improve understanding and emotional support 13 (Evidence: Expert opinion).

    • References

    1 Lapere S, Weis E. Tele-ophthalmology for the monitoring of choroidal and iris nevi: a pilot study. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2018. link 2 Williams DS. Choroidal Nevi. Journal of insurance medicine (New York, N.Y.) 2016. link 3 Chranioti AA, Malamas AA, Diavati O, Ziakas NG, Maloutas SG, Oikonomidis PK. Retrospective study of choroidal melanomas at the 1(st) Department of Ophthalmology, AHEPA hospital, Thessaloniki, from 2002 to 2011. Indian journal of cancer 2016. link 4 Al-Jamal RT, Cassoux N, Desjardins L, Damato B, Konstantinidis L, Coupland SE et al.. The Pediatric Choroidal and Ciliary Body Melanoma Study: A Survey by the European Ophthalmic Oncology Group. Ophthalmology 2016. link 5 Sallam A, Hungerford J. Choroidal melanoma. British journal of hospital medicine (London, England : 2005) 2007. link 6 Lederer DE, Edelstein C. Choroidal melanoma: clinical presentation and differential diagnosis. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2004. link80006-1) 7 Shields JA, Shields CL, Materin MA, Marr BP, Demirci H, Mashayekhi A. Changing concepts in management of circumscribed choroidal hemangioma: the 2003 J. Howard Stokes Lecture, Part 1. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye 2004. link 8 Sia S, Harper C, McAllister I, Perry A. Treatment of choroidal melanoma by stereotactic radiosurgery. Australasian radiology 2000. link 9 Ip M, Kroll A, Reichel E. Transpupillary thermotherapy. Seminars in ophthalmology 1999. link 10 Gündüz K, Shields CL, Shields JA. Varix of the vortex vein ampulla simulating choroidal melanoma: report of four cases. Retina (Philadelphia, Pa.) 1998. link 11 Abramson DH, Servodidio CA. Dislocated intraocular lens simulating a choroidal melanoma. Insight (American Society of Ophthalmic Registered Nurses) 1995. link 12 Servodidio CA. Human responses to the diagnosis of choroidal melanoma. Journal of ophthalmic nursing & technology 1992. link 13 Servodidio CA. Teaching aids for patients diagnosed with choroidal melanoma. Insight (American Society of Ophthalmic Registered Nurses) 1991. link 14 La Piana FG. Modified enucleation. Advances in ophthalmic plastic and reconstructive surgery 1990. link 15 Chong CA, Gregor RJ, Augsburger JJ, Montana J. Spontaneous regression of choroidal melanoma over 8 years. Retina (Philadelphia, Pa.) 1989. link 16 Péraldi S, Nguyen Than Dao B, Brabet P, Homburger V, Rouot B, Toutant M et al.. Apical localization of the alpha subunit of GTP-binding protein Go in choroidal and ciliated ependymocytes. The Journal of neuroscience : the official journal of the Society for Neuroscience 1989. link 17 Snyder WB, Fuller DG, Fish GE. An inexpensive fiberoptic light pipe to aid in placement of episcleral radioactive plaques. Ophthalmic surgery 1988. link 18 Packer S, Fairchild RG, Salanitro P. New techniques for iodine-125 radiotherapy of intraocular tumors. Annals of ophthalmology 1987. link 19 Leff SR, Augsburger JJ, Shields JA. Focal fluorescence of choroidal melanoma. The British journal of ophthalmology 1986. link 20 Davey CC, Deery AR. Through the eye, a needle: intraocular fine needle aspiration biopsy. Transactions of the ophthalmological societies of the United Kingdom 1986. link 21 Packer S. Tumor detection with radiopharmaceuticals. Seminars in nuclear medicine 1984. link80052-5) 22 Lindsey PS, Shields JA, Goldberg RE, Augsburger JJ, Frank PE. Bilateral choroidal hemangiomas and facial nevus flammeus. Retina (Philadelphia, Pa.) 1981. link 23 Shammas HF, Wood LW. Choroidal melanoma and retinal tear. Archives of ophthalmology (Chicago, Ill. : 1960) 1977. link 24 Shields JA, Tasman WS. B-scan ultrasonography of lesions simulating choroidal melanomas. Modern problems in ophthalmology 1977. link 25 Blodi FC. Pathology of choroidal melanomas. Unusual aspects confusing the clinical diagnosis. Transactions of the ophthalmological societies of the United Kingdom 1977. link 26 Hoskins JC, Kearney JJ. A case report of a negative 32P test in a histologically proven choroidal hemangioma. Archives of ophthalmology (Chicago, Ill. : 1960) 1977. link 27 Lommatzsch P, Dietrich B. The effect of orbital irradiation on the survival rate of patients with choroidal melanoma. Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde 1976. link 28 Craandijk A, Van Beek CA. Indocyanine green fluorescence angiography of the choroid. The British journal of ophthalmology 1976. link 29 Addison DJ, Wakelin MD. Errors in the diagnosis of choroidal malignant melanoma. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 1975. link 30 Awan KJ. Expulsive choroidal hemorrhage. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 1975. link

    Original source

    1. [1]
      Tele-ophthalmology for the monitoring of choroidal and iris nevi: a pilot study. — Lapere S, Weis E Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (2018)
    2. [2]
      Choroidal Nevi. — Williams DS Journal of insurance medicine (New York, N.Y.) (2016)
    3. [3]
      Retrospective study of choroidal melanomas at the 1(st) Department of Ophthalmology, AHEPA hospital, Thessaloniki, from 2002 to 2011. — Chranioti AA, Malamas AA, Diavati O, Ziakas NG, Maloutas SG, Oikonomidis PK Indian journal of cancer (2016)
    4. [4]
      The Pediatric Choroidal and Ciliary Body Melanoma Study: A Survey by the European Ophthalmic Oncology Group. — Al-Jamal RT, Cassoux N, Desjardins L, Damato B, Konstantinidis L, Coupland SE et al. Ophthalmology (2016)
    5. [5]
      Choroidal melanoma. — Sallam A, Hungerford J British journal of hospital medicine (London, England : 2005) (2007)
    6. [6]
      Choroidal melanoma: clinical presentation and differential diagnosis. — Lederer DE, Edelstein C Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (2004)
    7. [7]
      Changing concepts in management of circumscribed choroidal hemangioma: the 2003 J. Howard Stokes Lecture, Part 1. — Shields JA, Shields CL, Materin MA, Marr BP, Demirci H, Mashayekhi A Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye (2004)
    8. [8]
      Treatment of choroidal melanoma by stereotactic radiosurgery. — Sia S, Harper C, McAllister I, Perry A Australasian radiology (2000)
    9. [9]
      Transpupillary thermotherapy. — Ip M, Kroll A, Reichel E Seminars in ophthalmology (1999)
    10. [10]
      Varix of the vortex vein ampulla simulating choroidal melanoma: report of four cases. — Gündüz K, Shields CL, Shields JA Retina (Philadelphia, Pa.) (1998)
    11. [11]
      Dislocated intraocular lens simulating a choroidal melanoma. — Abramson DH, Servodidio CA Insight (American Society of Ophthalmic Registered Nurses) (1995)
    12. [12]
      Human responses to the diagnosis of choroidal melanoma. — Servodidio CA Journal of ophthalmic nursing & technology (1992)
    13. [13]
      Teaching aids for patients diagnosed with choroidal melanoma. — Servodidio CA Insight (American Society of Ophthalmic Registered Nurses) (1991)
    14. [14]
      Modified enucleation. — La Piana FG Advances in ophthalmic plastic and reconstructive surgery (1990)
    15. [15]
      Spontaneous regression of choroidal melanoma over 8 years. — Chong CA, Gregor RJ, Augsburger JJ, Montana J Retina (Philadelphia, Pa.) (1989)
    16. [16]
      Apical localization of the alpha subunit of GTP-binding protein Go in choroidal and ciliated ependymocytes. — Péraldi S, Nguyen Than Dao B, Brabet P, Homburger V, Rouot B, Toutant M et al. The Journal of neuroscience : the official journal of the Society for Neuroscience (1989)
    17. [17]
      An inexpensive fiberoptic light pipe to aid in placement of episcleral radioactive plaques. — Snyder WB, Fuller DG, Fish GE Ophthalmic surgery (1988)
    18. [18]
      New techniques for iodine-125 radiotherapy of intraocular tumors. — Packer S, Fairchild RG, Salanitro P Annals of ophthalmology (1987)
    19. [19]
      Focal fluorescence of choroidal melanoma. — Leff SR, Augsburger JJ, Shields JA The British journal of ophthalmology (1986)
    20. [20]
      Through the eye, a needle: intraocular fine needle aspiration biopsy. — Davey CC, Deery AR Transactions of the ophthalmological societies of the United Kingdom (1986)
    21. [21]
      Tumor detection with radiopharmaceuticals. — Packer S Seminars in nuclear medicine (1984)
    22. [22]
      Bilateral choroidal hemangiomas and facial nevus flammeus. — Lindsey PS, Shields JA, Goldberg RE, Augsburger JJ, Frank PE Retina (Philadelphia, Pa.) (1981)
    23. [23]
      Choroidal melanoma and retinal tear. — Shammas HF, Wood LW Archives of ophthalmology (Chicago, Ill. : 1960) (1977)
    24. [24]
      B-scan ultrasonography of lesions simulating choroidal melanomas. — Shields JA, Tasman WS Modern problems in ophthalmology (1977)
    25. [25]
      Pathology of choroidal melanomas. Unusual aspects confusing the clinical diagnosis. — Blodi FC Transactions of the ophthalmological societies of the United Kingdom (1977)
    26. [26]
      A case report of a negative 32P test in a histologically proven choroidal hemangioma. — Hoskins JC, Kearney JJ Archives of ophthalmology (Chicago, Ill. : 1960) (1977)
    27. [27]
      The effect of orbital irradiation on the survival rate of patients with choroidal melanoma. — Lommatzsch P, Dietrich B Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde (1976)
    28. [28]
      Indocyanine green fluorescence angiography of the choroid. — Craandijk A, Van Beek CA The British journal of ophthalmology (1976)
    29. [29]
      Errors in the diagnosis of choroidal malignant melanoma. — Addison DJ, Wakelin MD Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (1975)
    30. [30]
      Expulsive choroidal hemorrhage. — Awan KJ Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (1975)
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