Uveal melanoma physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Common physical examination findings of uveal melanoma include presence of dark spot on the iris, anisicoria, loss of peripheral vision, decreased visual acuity and photopsia.
Physical Examination
HEENT
- Dark spot is present on the iris
- Anisicoria
- Loss of peripheral vision
- Decreased visual acuity
- Photopsia
- Visual field tests
The ophthalmologist uses the following instruments to look inside the eye for a tumor:
- An ophthalmoscope (also known as a direct ophthalmoscope).
- An indirect ophthalmoscope and a slit lamp is more like a large microscope.
- A gonioscopy lens.
Diagnosis of uveal melanoma is based on a combination of clinical examination with indirect ophthalmoscopy, slit lamp biomicroscopy, and ultrasonography
- Iris melanomas are detectable by slit lamp biomicroscopy, on the other hand ciliary body tumours are hidden behind the iris and can be visualized by ultrasonography. Depending on their location, choroidal tumours, are diagnosed by dilated indirect ophthalmoscopy and ultrasonography.
- Indirect ophthalmoscopy through a dilated pupil provides a correct diagnosis in more than 95% of the cases. Accuracy of the correct diagnosis is established to be over 99% by experienced clinicians with ophthalmoscopy, ultrasound, and fluorescein angiography and confirmed by histopathology.[1]
- The clinical diagnosis of uveal melanoma can be made on dilated fundus exam when the classical appearance of a pigmented dome shaped mass extends from the ciliary body or choroid indicating that the tumor has extended through Bruch’s membrane. Approximately 20% of lesions will take on a large, mushroom shape.
The appearance of melanoma depends on its location and size, whether it is in the iris or the choroid.
- Iris melanoma appears as a brown or yellow nodule on the iris. It is usually visible to the patient.
- Choroidal melanoma appears as a yellow or brown or tumor in the back of the eye and is not visible to the patient.
References
- ↑ van, J.G.M.; Koopmans, A.E.; Verdijk, R.M.; Naus, N.C.; de, A.; Kilic, E. (2013). "Diagnosis, Histopathologic and Genetic Classification of Uveal Melanoma". doi:10.5772/53631.