2020–2021 BCSC Basic and Clinical Science Course™
4 Ophthalmic Pathology and Intraocular Tumors
Part II: Intraocular Tumors: Clinical Aspects
Chapter 17: Melanocytic Tumors
This chapter includes related videos. Go to www.aao.org/bcscvideo_section04 or scan the QR codes in the text to access this content.
Uveal melanomas may develop in the iris, ciliary body, or choroid. Ciliary body and choroidal melanomas carry a worse prognosis than iris melanomas because of their substantially higher risk for metastasis. The spread of uveal melanomas is typically hematogenous.
Signs suggestive of iris melanoma include large size, prominent ectropion uveae, intratumoral vascularity, sectoral cataract, secondary glaucoma, seeding of the iris stroma and peripheral angle structures, extrascleral extension, and documented progressive growth.
Because of the risk for malignant transformation, iris and choroidal nevi should be documented with photographs and observed for growth. Nevi of the ciliary body are infrequent in general and are often not identified clinically because of their location (ie, they are not typically visible on clinical examination).
Posterior uveal melanomas arising from the ciliary body and choroid are associated with a high mortality rate. Referral to an ocular oncologist should be considered for patients with tumors displaying features suggestive of malignancy.
Large ciliary body and choroidal melanomas may be associated with vision loss due to serous retinal detachment or vitreous hemorrhage; however, many uveal melanomas are asymptomatic.
Features suggestive of choroidal melanoma include large size, presence of subretinal fluid, surface lipofuscin, vision symptoms, and documented growth.
Uveal melanomas may be treated with enucleation, brachytherapy or proton beam therapy, or excision, depending on the size and location of the tumor.
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.