This 81yo presented with peripheral vision loss. Vision was 20/100.
She had a large nasal uveal melanoma draping over the optic nerve. The tumor measured 10 mm in thickness and over 23 mm in basal diameter on B-scan ultrasonography.
Enucleation was recommended.
Learning Points:
Clinical characteristics of choroidal nevi at risk for progressing to a uveal MM were described by Shields et al. (Ophthalmology 1995;102:1351-1361). The most recent version of this famous acronym, To Find Small Ocular Melanoma Doing Imaging (TFSOM-DIM, Retina 2019;39:1840-1851) is:
To (Thickness >2mm)
Find (Subretinal Fluid)
Small (Symptoms, vision <= 20/50)
Ocular (Orange pigment)
Melanoma (Melanoma hollow)
DIM (DIaMeter >5mm)
