Melanoma of the choroid

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? Ultrasonography helps to confirm the diagnosis and the size of the tumour. Melanomas tend to have a distinct elevated dome shape with low internal acoustic reflectivity. Fluorescein angiography may show intrinsic vascularity and mottled hyperfluorescence

? Systemic imaging investigations and blood tests are largely concerned with diagnosing metastases, which occur most commonly in the liver, bone, skin and central nervous system. These tests are usually performed under the supervision of a medical oncologist.

Surgery

Therapeutic modalities include plaque or external beam radiotherapy, thermo-therapy, laser photocoagulation, chemotherapy and surgery. The classic treatment for choroidal melanoma has been enucleation, particularly for large or complex tumours. However, the Collaborative Ocular Melanoma Study (COMS) did not find a reduction in the 10-year mortality rate following enucleation compared to use of radioactive plaques. Radiotherapy, either with radioactive plaque or charged particles, is recommended for medium-sized and large melanomas when there is a possibility of salvaging some vision. Management of small tumours, with little evidence of growth, is controversial: they may be treated or observed.