This patient was referred by the optician because of this pigmented lesion.

What features in the ultrasound favour a diagnosis of choroidal melanoma?

Answer
Elevated lesion with choroidal excavation on B-scan
Low internal reflectivity (acoustic hollowness) on A-scan
 

The ultrasound shows a lesion with a thickness of 1.9 mm and a base diameter of 7 mm with low internal reflectivity. What treatment options are there for this patient?

Answer
This is a small tumour and the treatment options include:
Observation
Photocoagulation
Transpupillary thermotherapy
Photodynamic therapy
Plaque radiotherapy
Proton-beam radiation
Partial lamellar scleruvectomy
Enucleation
 

The patient refuses treatment and is managed by observation. What clinical features are predictive of growth of small choroidal melanoma?

Answer
The five main clinical features predictive of growth of small choroidal melanoma are:
tumour thickness of greater than 2 mm
posterior margin touching the optic disc
visual symptoms
orange pigment
subretinal fluid
The risk increases with the number of risk factors.
(This is based on 1287 patients with small suspicious choroidal melanoma tumours measuring 3 mm or less in thickness, managed 
with observation. The follow up was 20 years with a median of
51 months.
The results were published in Combination of clinical factors 
predictive of growth of small choroidal melanocystic tumours. 
Arch Ophthalmol 2000 Mar: 118 (3): 360-4 Shields CL et al.)
 

What is shown in the picture below?

Answer
Plaque containing radioactive rods used for plaque radiotherapy 
of small to medium sized choroidal melanoma. The plaque is
sutured to the sclera over the lesion and leave for a few days before removing.

 

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