Posterior Uveal Melanoma

Uveal melanoma is a deadly ocular malignancy that involves predominantly the choroid. Once diagnosed, patients usually require long-term follow up to detect any local recurrence and metastatic disease to the liver, lung and skin. One must be competent at diagnosing choroidal melanoma in order to enable prompt intervention, which is critical to patient survival. When faced with the challenge of distinguishing it from an initial choroidal nevus or a nevus potentially transforming into a melanoma, especially small-sized, indicators for malignancy include presence of orange lipofuscin pigment, associated sub-retinal fluid, tumour proximity within 3mm of the optic disc, absence of halo or drusen, and symptoms of flashes, floaters or blurred vision. A comprehensive dilated fundus examination supplemented with fundus imaging such as optical coherence tomography and fundus auto-fluorescence is warranted. Ancillary testing using fluorescein and indocyanine green angiography, and ultrasonography demonstrating tumour hollowness in malignancy may also prove beneficial.