This healthy 42YO female presented with one and a half years of progressive vision in her right eye. Vision was counting fingers OD and 20/20 in her normal OS.
Pseudocolor SLO imaging shows a large, elevated pigmented choroidal lesion occupying the entire macula and extending into the midperiphery. OCT shows marked cystic outer retinal edema overlying the tumor. The lesion, which measures 6.9mm in thickness, has moderate homogenous internal reflectivity on B-scan ultrasonography. She was referred to ocular oncology for further evaluation and treatment.
Learning points:
Uveal malignant melanoma is a malignant tumor arising from melanocytes in the uveal tract (iris, ciliary body, or choroid). The choroid is the most common site, accounting for 90% of uveal melanomas. Uveal melanoma is the most common primary intraocular cancer in adults, whereas metastatic disease is the most common intraocular malignancy. The liver is the most common metastatic site, although metastatic disease is rare on presentation. Metastases are more common in large tumors, with BAP1 mutations, and with certain tumor-related genetic markers (including positive PRAME and Class 2).
