Choroidal Melanoma in an Asymptomatic Patient

Abstract

Introduction Choroidal melanoma is considered the most common intraocular malignancy found in adults and typically presents without symptoms in the early stages. They are frequently first seen on routine dilated fundoscopic exams and appear as a pigmented or nonpigmented choroidal lesion. Case Presentation A 58-year-old Caucasian female presented for a comprehensive eye exam with a chief complaint of gradual distance blur in both eyes. On funduscopic examination of the right eye, a suspicious faint, variably pigmented large choroidal lesion was noted adjacent to the optic nerve. The patient was referred to a retinal oncologist for further workup and management. Management and Outcome The retinal oncologist performed multiple imaging tests including B-scan ultrasound, OCT, and Fundus Autofluorescence which revealed a choroidal mass with subretinal fluid, and presence of lipofuscin confirming a diagnosis of a small choroidal melanoma. Systemic workup did not reveal any metastasis of the choroidal lesion. The patient was initially treated surgically with plaque radiotherapy; however, the patient developed ocular complications ultimately leading to enucleation of the right eye. Consequently, the patient was fitted with an ocular prosthesis. Discussion Choroidal melanomas are the most common intraocular malignancy found in adults and encompass 80% of all uveal melanomas. Patients with choroidal melanoma are typically asymptomatic and are commonly first seen on routine dilated fundoscopic exams. Metastasis of choroidal melanomas are rare but can occur in 1-2% of all cases mainly to the liver, bone, and lung. A 50% mortality rate in a 10-year span has been noted for metastasized choroidal melanomas. Ancillary imaging modalities such as Optical coherence tomography, Fundus Autofluorescence, and B-scan ultrasound are useful in aiding in the diagnosis. Treatment and management are modified based on the characteristics of the tumor and patient, which can include brachytherapy, external beam radiotherapy, stereotactic radiotherapy, transpupillary thermotherapy, and enucleation. Timely detection and treatment are key in managing this sight and life-threatening illness CE Notification This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/choroidal-melanoma-in-an-asymptomatic-patient) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.