Choroidal melanoma
 

Choroidal naevus or melanoma may be easily missed if you were asked to examine with an direct ophthalmoscope especially if the lesion is only slightly pigmented. Remember to look for this if the optic disc, macula and retinal vessels are normal. The lesion appears as an elevated, pigmented mass. There may be orange pigment (lipofuscin) on the tumour. Look for any retinal detachment around it. In melanoma treated with plaque, the surrounding area shows atrophy or surrounded by hard exudate (see the picture on the left). Other signs: Rarely the patient may have ipsilateral facial hyperpigmentation due to naevus of Ota which is associated with increased risk of melanoma.

Questions:

1. What treatment options are available for choroidal melanoma?

Answer
Goals of treatment are the eradication oft he primary tumour, preservation of the globe and the preservation of useful vision in that order. Factors affecting treatment options include tumour thickness and position.
The therapeutic options include:
observation
enucleation (large tumour)
laser photocoagulation
irradiation using a local scleral plaque (⁶⁰Co, ¹²⁵ I etc)
local resection
cryotherpy
exenteration if there is spread outside the globe

2. What are the cell types seen in uveal melanoma?

Answer
Three types are described:
spindle A =  slender spindle-shaped cell with a flattened nucleus, no nucleolus and a prominent basophilic nuclear line caused by infolding of the nuclear membrane.
spindle B = larger spindle-shaped  cell with a round or oval nucleus, a prominent nucleolus and poorly differentiated cytoplasmic borders.
epitheloid cells = nuclei are typically round and eccentrically positioned. The cell membrane is well-demarcated. This type has a high mitotic figure.

 

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