Debunking intraocular ocular tumor misconceptions

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Common misconceptions about identifying and diagnosing melanoma were debunked at a presentation by Jesse Berry, MD at Hawaiian Eye and Retina 2021.  

Although only 5% of all melanoma diagnoses in the United States are in the eye, it is the most common site of primary intraocular ocular tumors in adults, with approximately 1500 cases per year. It is most common in Caucasians between the ages of 50-70 years and fundoscopy and ultrasound are the most common methods used to diagnose.

Dr Berry said it’s often assumed that everything that is pigmented is a melanoma. However, she said that there are many other explanations for pigmentation, including CHRPE, choroidal nevus, melanocytoma, and vortex varix.

Keeping that in mind, Dr Berry said ophthalmologists might then believe that everything that is pigmented and elevated is a melanoma. Choroidal nevus, however, is often a differential diagnosis. Signs to look out for that may indicate choroidal nevus over melanoma include thickness >2 mm, fluid, symptoms, and orange pigment.

That doesn’t mean however that everything that is pigmented and elevated is either melanoma or high-risk choroidal nevus. One possible diagnosis is peripheral exudative hemorrhagic chorioretinopathy, which is more common in elderly Caucasian patients and associated with drusen and blood thinner use.

Berry JL. Rumors about Tumors: Top Do Not Miss Tips from an Ocular Oncologist. Presented at: Hawaiian Eye & Retina 2021

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