Choroidal Melanomas

Signature Grand, Davie, Florida, USA

Background. Choroidal melanomas are the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma in the body. This lesion is most commonly found in people of northern European descent and slightly more in males than females. Incident of choroidal melanoma is highest around age 55 years. Ocular symptoms of choroidal melanoma include blurred vision, painless and progressive field loss, floaters, and severe ocular pain. If a lesion is suspected of being a choroidal melanoma, treatment modalities such as enucleation, plaque brachytherapy, external beam radiation, or laser photocoagulation and transpupillary thermotherapy may be implemented. These lesions have a very high fatality rate---about 30-50% of patients with choroidal melanoma will die within 10 years from diagnosis and treatment—therefore, timely diagnoses and referral is essential for preservation of the patient’s vision and life. Case Report. A 26-year-old white female presented with history of decrease vision in the right eye over the past few weeks. Ocular history and medical history is noncontributory. Best-corrected vision was CF@ 3ft in the right eye and 20/20 in the left eye. Examination of anterior segment revealed an APD in the right eye with all other findings within normal limits. Fundus examination revealed a large elevated white mass in the right eye. After a thorough examination and testing, a diagnosis of choroidal melanoma was made and a referral was generated. Treatment of plaque brachytherapy and laser photocoagulation was implemented. Discussion. Enucleation is typically done for large tumors where the basal diameter is greater than 15 mm and the height is greater than 10mm. Plaque brachytherapy is a widely accepted alternative mostly used for medium size melanomas where the basal diameter is less than 15 mm and the height is less than 10mm. However, there is a great possibility that there might be a chance for recurrence, which then leaves no option but to enucleate the eye. External beam irradiation has a success rate similar to plaque brachytherapy and typically used for medium size melanomas. Laser photocoagulation and transpupillary thermotherapy are used for smaller melanomas or can be used in conjunction with some of the other treatments to decrease the chances of recurrence. Conclusion. A discussion of the case presented aims to provide clinicians with a clearer understanding of the clinical findings, differential diagnoses, and management of choroidal melanomas.