A CASE OF SMALL CHOROIDAL MELANOMA

Title A CASE OF SMALL CHOROIDAL MELANOMA
Author, Co-Author Andrea Yiasemis
Topic
Year
2010
Day
Thursday
Program Number
105727
Room
Third Floor Foyer
Affiliation
VA Medical Center
Abstract BACKGROUND: Primary choroidal melanomas account for approximately 80% of all uveal melanomas. Patients are often asymptomatic unless the tumor is located at or near the macula, with the lesions often discovered incidentally upon routine eye exam. Various treatment options including observation, radiation, photocoagulation, transpupillary thermotherapy, and enucleation may be employed depending on the size and location of tumor.

CASE REPORT(S): A 68 year old male presented to the Fresno VA complaining of reduced vision in both eyes. His last eye exam was 2 months prior, but he was not told the cause of his reduced vision. His medical history included hypertension, diabetes, congestive heart failure, and chronic kidney disease. BCVAs were 20/70 OD and 20/50 OS. No APD was noted. EOMs, intraocular pressures and anterior segment exam were unremarkable. Dilation revealed a 6.5x4.5DD elevated, greenish-grey lesion along the inferior arcade of the right eye approaching the inferior aspect of the fovea. Subretinal fluid was noted overlying the lesion. Ultrasound showed an elevated mass 1.6mm in height with low to medium reflectivity. The patient was referred to an ocular oncologist who confirmed the diagnosis of a small choroidal melanoma. The patient subsequently received a total of 56 Gy of proton beam radiation. Systemic workup for primary cancer or metastasis was unremarkable. At 6 week follow-up s/p radiation, the patient’s BCVA was stable OU.

CONCLUSIONS: Accurately diagnosing choroidal melanomas may be challenging given variable clinical presentations, however ancillary testing may aid in the diagnosis. The overall prognosis for small melanomas is very favorable with prompt referral and treatment, as long as no metastatic disease is identified.
Affiliation of Co-Authors
Outline