What Is Choroidal Melanoma?

Choroidal melanoma is a common malignant tumor in the eye. It is more common in 40 to 60 years of age. It has nothing to do with sex or the eye. It can occur in any part of the choroid, but it is common in the posterior pole of the eye.

Basic Information

English name: melanoma of choroid
Multiple groups: 40 to 60 years old

Common symptoms: Loss of vision, visual field defect, distortion of vision, dark shadow in front of eyes, change of color vision, etc.

Causes of choroidal melanoma

The specific cause is unknown. May be related to race, family and endocrine factors. Other factors including sunlight exposure, certain viral infections, and exposure to certain carcinogenic chemicals may be related to the onset of the disease.

Clinical manifestations of choroidal melanoma

Choroidal melanoma, if located in the periphery of the fundus, is often without symptoms at an early stage. If located in the posterior pole, patients often complain of early vision loss, visual field defects, deformed vision, dark shadows in front of the eyes, changes in color vision, and increased refractive power of persistent hyperopia. Severe vision loss can occur when the tumor is enlarged and secondary retinal detachment occurs. Fundus examination showed a solid choroidal bulge, mostly tan color, bleeding on the surface, and exudative detachment of the retina surrounding the tumor. When the tumor is necrotic, it can be combined with iris ciliary body inflammation, anterior chamber pseudopurulent, anterior chamber pigmentation, and anterior chamber hemorrhage. Macrophages engulf tumor cells, pigment granules, or necrotic residues. Freeing to the anterior chamber can cause increased intraocular pressure. It can also increase intraocular pressure due to iris neovascularization, which can cause neovascular glaucoma.

Choroidal melanoma test

1. fluorescein fundus angiography (FFA)

Comprehensive analysis of the early, arteriovenous and advanced stages of angiography, and pay attention to distinguish them from choroidal hemangiomas and choroidal metastases.

2. Ultrasound exploration

Can detect tumor solid sonogram. It is more valuable when the refractive interstitial opacity ophthalmoscope cannot be examined, or with severe retinal detachment, and the tumor is covered by it.

3.CT and MRI scans

CT scan showed localized thickening of the eye ring, protruding to the inside or outside of the ball. MRI scans can not only show the changes of solid choroid space, but also have certain qualitative value for the diagnosis of choroidal melanoma.

4. Full physical examination

Because choroidal melanoma is most likely to metastasize to the liver via blood circulation, liver ultrasound and liver scintigraphy can check for tumor metastasis. Similarly, chest X-rays or CT scans can also help find metastatic disease.

Choroidal melanoma diagnosis

Based on typical clinical manifestations, examinations, and histopathological findings, it is not difficult to diagnose the disease.

Histopathological changes: Choroidal melanoma is composed of different morphology of cells, cytoplasm and nucleus. It contains different levels of melanin, some are non-pigmented, some are completely black, some are gray or brown, most blood vessels are abundant, and some blood vessels are more Thick, but thin wall. Therefore, bleeding and necrosis are often seen in large tumors.

Differential diagnosis of choroid melanoma

It is often confused with some similar fundus diseases in clinic. Differential diagnosis should be paid attention to.

Choroid melanoma

Choroid melanoma is a benign tumor. The fundus changes are similar to those of choroid melanoma, but the development of choroid melanoma is relatively slow and will not affect the patient's life.

2. Choroidal hemorrhage and subretinal pigment epithelium hemorrhage

Fundus image of this disease is sometimes similar to choroidal melanoma. Fundus fluorescein angiography (FFA) is extremely important in differential diagnosis. The choroidal fluorescence at the bleeding focus is masked to show a clear non-fluorescent area. The arterial and venous phases can only see the retinal arteriovenous crawling on the surface of the non-fluorescent area, which has new lake-like fluorescent spots and neovascular infiltration in the tumor surface Leaks are different. In addition, choroidal hemorrhage and subretinal pigment epithelium hemorrhage can be reduced and disappeared by hemostasis and bleeding absorption drug treatment; as the disease progresses, the tumor can also become smaller or disappear with the absorption of bleeding.

3. Choroidal hemangioma

It can also be similar to the pigment of this disease, and there are new blood vessels on its surface. However, hemangiomas mostly coexist with hemangiomas on the skin, lips, or hard palate; solitary choroidal hemangiomas are relatively rare. In addition to blood sinusoidal fluorescence at the late stage of FFA, calcification points are often seen on X-ray films at the late stage of the disease. different.

4. Exudative age-related macular degeneration

When a large subretinal hemorrhage occurs to form a hematoma, it is easily confused with the disease. When the two fluorescein angiography cannot be fully determined, CT scan and ultrasound examination can help to distinguish.

5. Choroidal metastases

Choroidal metastatic cancer generally spreads along the choroidal level and rarely shows a localized bulge, which is the opposite of the disease; metastatic cancer develops rapidly and develops rapidly. The disease grows slowly before breaking through the Bruch membrane. In addition, if the primary lesion can be found (such as breast cancer, lung cancer, etc.) is the most powerful basis for differential diagnosis.

Choroidal melanoma treatment

Currently choroidal melanoma is usually treated with a comprehensive treatment plan. For tumors that are small and have good visual function, patients who strongly require eyeball maintenance can use lasers, topical radiotherapy or local resection of tumors. If the tumors are large and the visual function is severely damaged, or the patient strongly demands eyeball removal, Eyeball removal combined with ocular stage implantation can be performed. If the tumor cells have metastasized from the eye to the orbit, orbital enucleation can be performed. Depending on the situation after surgery, immunotherapy can be given.