Choroidal Melanoma Management
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Questions and Answers

What thickness measurement is considered suspicious for malignant transformation in ocular conditions?

  • Less than 1 mm
  • Exactly 2 mm
  • Between 3 mm and 4 mm
  • Greater than 2 mm (correct)
  • Which symptom is NOT associated with suspicious signs for melanoma?

  • Subretinal fluid
  • Loss of visual acuity of 20/50 or worse
  • Presence of orange pigment
  • Feeding difficulties (correct)
  • The presence of which feature is more likely associated with melanoma rather than a nevus?

  • Hollowness on B scan (correct)
  • Halo presence
  • Thickness less than 2 mm
  • Drusen
  • Which of the following factors is NOT typically considered when determining the treatment for choroidal melanoma?

    <p>Treatment cost</p> Signup and view all the answers

    What is the risk of malignant transformation within 5 years if one risk factor is present?

    <p>38%</p> Signup and view all the answers

    Which factor does NOT indicate a higher risk of malignant transformation?

    <p>Presence of drusen</p> Signup and view all the answers

    Which management approach is specifically aimed at preserving vision in choroidal melanoma cases?

    <p>Laser photocoagulation</p> Signup and view all the answers

    What is the significance of chromosome abnormalities in choroidal melanoma management?

    <p>They indicate a higher chance of metastasis.</p> Signup and view all the answers

    If a patient exhibits all five risk factors for choroidal nevus transformation, what is the estimated risk of malignant transformation at 15 years?

    <p>95%</p> Signup and view all the answers

    Which ultrasonographic sign is most indicative of melanoma?

    <p>Acoustic hollowness</p> Signup and view all the answers

    Which of the following is a common differential diagnosis for choroidal melanoma?

    <p>Choroidal nevus</p> Signup and view all the answers

    The two cell types that are most relevant in the prognostic factors for choroidal melanoma are:

    <p>Epithelioid cells and spindle A/B cells</p> Signup and view all the answers

    Which of the following is not a suspicious sign for melanoma growth?

    <p>Halo presence</p> Signup and view all the answers

    Which novel therapeutic approach is NOT commonly used in the management of choroidal melanoma?

    <p>Laser photocoagulation</p> Signup and view all the answers

    What percentage of choroidal melanoma patients may experience metastasis within ten years?

    <p>34%</p> Signup and view all the answers

    Which of the following treatment options is most invasive for managing choroidal melanoma?

    <p>Surgery (enucleation)</p> Signup and view all the answers

    What is a primary characteristic of diffuse choroidal hemangioma associated with Sturge-Weber syndrome?

    <p>Marked retinal vascular tortuosity</p> Signup and view all the answers

    Which imaging technique is NOT mentioned as showing features of circumscribed and diffuse choroidal hemangioma?

    <p>Fundus photography</p> Signup and view all the answers

    Which of the following is a complication of choroidal hemangioma?

    <p>Fibrous metaplasia of overlying retinal pigment epithelium (RPE)</p> Signup and view all the answers

    What does the late 'wash-out' phenomenon signify in ICG angiography for choroidal hemangioma?

    <p>Early hyperfluorescence followed by late hypofluorescence</p> Signup and view all the answers

    Which of the following is NOT a feature observed in ultrasounds of choroidal hemangioma?

    <p>Thinning of the retina</p> Signup and view all the answers

    When is diffuse choroidal hemangioma generally diagnosed?

    <p>Usually evident at birth</p> Signup and view all the answers

    What characteristic shape is typically seen in choroidal hemangioma lesions?

    <p>Smooth dome-shaped</p> Signup and view all the answers

    What is typically observed in the early phase of fluorescein angiography for both forms of choroidal hemangioma?

    <p>Diffuse hyperfluorescence</p> Signup and view all the answers

    What is the typical location of a choroidal hemangioma?

    <p>Mostly located in the posterior pole region</p> Signup and view all the answers

    Which symptom is commonly associated with a choroidal hemangioma when it causes complications?

    <p>Flashes of light</p> Signup and view all the answers

    What characteristic distinguishes a circumscribed choroidal hemangioma?

    <p>Raised, dome-shaped with distinct margins</p> Signup and view all the answers

    At what stage of life is a circumscribed choroidal hemangioma usually diagnosed?

    <p>When visually symptomatic in the 2nd to 4th decades</p> Signup and view all the answers

    How is the risk of malignant transformation related to the number of risk factors?

    <p>3 or more risk factors can approach a 100% risk</p> Signup and view all the answers

    Which feature is not characteristic of a choroidal hemangioma?

    <p>Composed of large immature choroidal cells</p> Signup and view all the answers

    What describes the typical appearance of a choroidal hemangioma?

    <p>Raised and dome-shaped with distinct margins</p> Signup and view all the answers

    Which is not a typical symptom of choroidal hemangioma?

    <p>Severe eye pain</p> Signup and view all the answers

    What treatment option is typically used for symptomatic choroidal hemangioma?

    <p>Enucleation</p> Signup and view all the answers

    Which feature is NOT typical for choroidal osteoma?

    <p>Bilateral occurrence</p> Signup and view all the answers

    What is a common complication associated with choroidal hemangioma?

    <p>Secondary glaucoma</p> Signup and view all the answers

    Which diagnostic tool is used to assess choroidal osteoma?

    <p>Ultrasonography</p> Signup and view all the answers

    Which demographic is most commonly affected by choroidal osteoma?

    <p>Young healthy women</p> Signup and view all the answers

    What is a characteristic of choroidal osteoma as it progresses?

    <p>Calcification over time</p> Signup and view all the answers

    Which therapy is least likely to be beneficial for asymptomatic choroidal hemangioma?

    <p>Observation</p> Signup and view all the answers

    In terms of visual acuity, what percentage of choroidal hemangioma patients demonstrate a visual acuity of less than 20/40?

    <p>More than 50%</p> Signup and view all the answers

    Study Notes

    Choroidal Melanoma Management

    • Objective: Eradicate cancer, save life, preserve eye and vision.
    • Treatment determination factors: Tumor size, location, activity, potential for vision preservation, status of opposite eye, patient's age, general health, and presence of metastasis.

    Conventional and Novel Treatment Approaches

    • Conventional methods include observation, laser photocoagulation, transpupillary thermotherapy, various radiation therapies (plaque brachytherapy, external beam), and surgical options (local resection, enucleation, exenteration).
    • Novel therapeutic methods focus on immunotherapy and gene therapy.

    Prognostic Factors for Choroidal Melanoma

    • Cell types include spindle A/B cells, intermediate cells, and epithelioid cells.
    • Cytogenetic abnormalities often involve chromosomes 3, 6, 8, 9.
    • Tumor size and growth pattern: ~1mm correlates with ~5% chance of metastasis.
    • Proximity to the optic disc and extraocular extension are significant.
    • Ten-year metastasis rate is ~34%, with a high overall mortality rate (30-50%) within a decade.

    Differential Diagnoses

    • Conditions to differentiate include choroidal nevus, melanocytoma, congenital hypertrophy of the RPE, choroidal hemangioma, choroidal metastasis, choroidal osteoma, and choroidal detachment.

    Choroidal Nevus vs. Melanoma

    • Suspicious indicators for malignant transformation include thickness >2mm, subretinal fluid, presence of symptoms, orange pigment, and margin <3mm from the optic disc.
    • Ultrasonographic hollowness and absence of drusen are more characteristic of melanoma than nevus.

    Malignant Transformation Risks from Choroidal Nevus

    • 5-year malignant transformation rates based on risk factors:
      • No risk factors: <3-5%
      • One risk factor: 38%
      • Two risk factors: 50%
      • Three or more risk factors: up to 100%, depending on specific combinations.

    Choroidal Hemangioma

    • Described as an uncommon, benign vascular tumor, typically red-orange and disc-shaped.
    • Commonly located in the posterior pole region and likely congenital, detected later in life.
    • Symptoms can include blurry vision, metamorphopsia, and flashes of light.

    Types of Choroidal Hemangioma

    • Circumscribed form: Raised, dome-shaped, distinct margins, usually unilateral, diagnosed primarily in the 2nd to 4th decades.
    • Diffuse form: Often linked to Sturge-Weber syndrome, characterized by more extensive retinal changes and generally identified earlier.

    Imaging Techniques

    • Fluorescein and indocyanine green angiography demonstrate similar features in both choroidal hemangioma forms.
    • Ultrasonography shows high internal reflectivity and indicates solid tumor characteristics.

    Complications of Choroidal Hemangioma

    • May lead to fibrous metaplasia of the RPE, retinal changes, serous retinal detachment, and secondary glaucoma.

    Management and Prognosis

    • Observation recommended if asymptomatic; therapies include photodynamic treatment, laser photocoagulation, transpupillary thermotherapy, radiation therapy, and anti-VEGF injections.
    • Generally poor prognosis due to potential complications, with over 50% of patients exhibiting visual acuity <20/40.

    Choroidal Osteoma

    • Classified as a benign ossifying tumor characterized by yellowish-white or orange lesions, often well-defined with scalloped edges.
    • Predominantly unilateral, commonly affecting young women in their 20s and 30s, and is slowly progressive.

    Diagnostic Imaging for Choroidal Osteoma

    • Imaging modalities include ultrasonography, computed tomography, and fluorescein angiography, with CT showing hyperintense lesions similar to bone tissue.

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    Description

    This quiz explores the management principles for choroidal melanoma, focusing on the factors that help determine the best treatment options. Key considerations include tumor characteristics, patient age, and the condition of the opposite eye. Understanding these factors is crucial for effective treatment and preserving vision.

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