gms | German Medical Science

Purpose: To understand progress in the management of choroidal melanoma over a 40 year period.

Methods: Retrospective review of published reports.

Results: Diagnostic improvement has been achieved over this period with <1% misdiagnosis; however, the most common pseudomelanomas include choroidal nevus, peripheral exudative hemorrhagic chorioretinopathy, congenital hypertrophy of the retinal pigment epithelium (RPE), RPE detachment, choroidal hemangioma, and others. Precursors of melanoma include choroidal melanocytosis with a 1/400 risk for melanoma and choroidal nevus with a 1/8000 risk for transformation to melanoma. Risk factors for early detection of choroidal melanoma are applicable to lesions of 3 mm or less in thickness and include thickness >2 mm, subretinal fluid, orange pigment, symptoms of flashes/floaters, and tumor margin near optic disc. Prognosis (metastasis at 10 years) of choroidal melanoma depends on several factors including age (young (18%) vs mid-adult (21%) vs older adult (33%)), tumor size (each millimeter increase in thickness adds 5% increase in metastasis), presence of melanocytosis (48% with melanocytosis vs 24% without melanocytosis), and genetic mutations (chromosome 3 monosomy plus 8q amplification imparts 37 times greater risk for metastasis). According to the American Joint Committee of Cancer (AJCC) classification of choroidal melanoma is predictive of prognosis with relative risk (RR) for metastasis (compared to smallest category T1) for T2 (RR 2), T3 (RR 4), and T4 (RR 8). There is no difference in prognosis of choroidal melanoma based on race.

Conclusion: Best prognosis for choroidal melanoma is early detection when the tumor is small (<3 mm), at earliest AJCC category (T1) and with fewer genetic mutations (normal chromosomes 3 and 8).