eMedicine Specialties > Ophthalmology > Choroid

Melanoma, Choroidal: Follow-up

Author: Enrique Garcia-Valenzuela, MD, PhD, Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center
Coauthor(s): Mauricio E Pons, MD, Associate Physician, Charles A Garcia, MD, PA; James E Puklin, MD, Professor, Department of Ophthalmology, Vitreoretinal Service, Kresge Eye Institute, Wayne State University; Cathleen A Davidson, MSc, Consulting Staff, Department of Obstetrics and Gynecology, Laboratory of Assisted Reproductive Technologies, University of Michigan
Contributor Information and Disclosures

Updated: Jun 24, 2009

Follow-up

Further Outpatient Care

  • Irrespective of the treatment modality chosen, patients with choroidal melanomas need to be observed carefully and for many years.
    • This is particularly true for small tumors, when the diagnosis is not established clearly. Close observation and measurement of the dimensions of the tumors with any of the diagnostic tools mentioned in Lab Studies is critical.
    • Repeat examinations usually are performed about every 3 months initially, and if no changes are seen, follow-up care is performed every 6 months. If growth of the lesion is detected, consider further treatment. Choroidal melanomas may show size regression starting several months after being treated with external beam irradiation or plaque brachytherapy. The goal of successful treatment is not necessarily reduction in size but long-term arrest of the tumor's growth.
    • Repeat examinations and imaging tests are performed after all treatment modalities because of the possibility of intraocular or extraocular tumor recurrence.
    • Follow-up care in patients with treated choroidal melanomas should include thorough physical examinations, liver function tests, and imaging of lungs, repeated about every 6-12 months. Early detection of distant metastases may affect management and survival.

Deterrence/Prevention

  • Patients with choroidal nevi, a family history of uveal melanoma, congenital ocular melanocytosis, dysplastic nevus syndrome, and other predisposing conditions of uveal melanoma may benefit from annual careful ophthalmologic examinations.
  • Limiting excessive ocular sunlight exposure through sunglasses or other means may have a theoretical preventive effect in patients with a predisposition to intraocular melanoma.

Prognosis

  • Visual prognosis is guarded for choroidal melanomas. The tumor or the treatment can cause a variety of ocular complications that severely affect vision, as discussed in Pathophysiology and Treatment. 
  • Choroidal melanomas have an overall mortality of about 30-50% within 10 years from initial diagnosis and treatment. Deaths are mostly secondary to distant metastases. Characteristics of the tumor that have been found to correlate with decreased survival include larger size, anterior location, transscleral extension, growth through the Bruch membrane, optic nerve extension, lack of pigmentation, increased vascularization, and histological features, such as mitotic activity and cell type.

Miscellaneous

Medicolegal Pitfalls

  • Two circumstances put choroidal melanoma in a special category regarding medical legal liability, as follows:
    • Other choroidal masses can present with very similar characteristics to choroidal melanoma, making it a challenging diagnosis.
    • Choroidal melanoma is a disease with a high mortality rate, usually irrespective of the chosen treatment modality.
 


More on Melanoma, Choroidal

Overview: Melanoma, Choroidal
Differential Diagnoses & Workup: Melanoma, Choroidal
Treatment & Medication: Melanoma, Choroidal
Follow-up: Melanoma, Choroidal
Multimedia: Melanoma, Choroidal
References
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References

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Further Reading

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Keywords

choroidal melanoma, malignant choroidal melanoma, intraocular tumor, intraocular melanoma, malignant tumor, malignant melanoma, uveal melanoma, primary malignant melanoma, anterior choroidal melanoma, posterior choroidal melanoma, anterior uveal melanoma, posterior uveal melanoma, uvea, iris, choroid, ciliary body, uveal structure

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Contributor Information and Disclosures

Author

Enrique Garcia-Valenzuela, MD, PhD, Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center
Enrique Garcia-Valenzuela, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Retina Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

Coauthor(s)

Mauricio E Pons, MD, Associate Physician, Charles A Garcia, MD, PA
Mauricio E Pons, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

James E Puklin, MD, Professor, Department of Ophthalmology, Vitreoretinal Service, Kresge Eye Institute, Wayne State University
Disclosure: Nothing to disclose.

Cathleen A Davidson, MSc, Consulting Staff, Department of Obstetrics and Gynecology, Laboratory of Assisted Reproductive Technologies, University of Michigan
Disclosure: Nothing to disclose.

Medical Editor

Russell P Jayne, MD, Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas
Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, and American Society of Retina Specialists
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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