Ultrasound detection of posterior scleral bowing in young patients with choroidal melanoma
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1Department of Ophthalmology, Ontario Cancer Institute, Princess Margaret Hospital, University of Toronto.
Insights
Posterior scleral bowing was detected in over half of young patients with choroidal melanoma. This ultrasound finding is distinct from choroidal excavation and aids in diagnosing this rare condition.
Area of Science:
- Ophthalmology
- Medical Imaging
- Oncology
Background:
- Choroidal melanomas are rare in patients under 30.
- Posterior scleral bowing was an observed ultrasound finding in some young patients with choroidal melanoma.
Purpose of the Study:
- To determine the incidence of posterior scleral bowing in young patients diagnosed with choroidal melanoma.
Main Methods:
- Retrospective review of 24 ultrasonograms from patients under 30 with choroidal melanoma.
- Analysis of ultrasonographic findings for posterior scleral bowing.
- Histopathological examination of available tumor samples.
Main Results:
- Posterior scleral bowing was identified in 58% of young patients with choroidal melanoma.
- Tumors associated with scleral bowing were smaller on average.
- Histopathology revealed more indolent cell types in the scleral bowing group.
Conclusions:
- Posterior scleral bowing is a common ultrasonographic finding in young patients with choroidal melanoma.
- This finding can be differentiated from choroidal excavation.
- Ultrasound is valuable for detecting scleral bowing in this demographic.
Background:
In evaluating young patients with choroidal melanomas, which are uncommon in people less than 30 years old, we noted that some had the ultrasound appearance of posterior scleral bowing. The purpose of this study was to determine the incidence of posterior scleral bowing in young patients with choroidal melanoma.
Methods:
We reviewed the ultrasonograms of 24 patients less than 30 years of age (mean age 25 years [standard deviation (SD) 4.7 years]) who presented to an ocular oncology service in Toronto between May 1984 and May 1997. In all cases the diagnosis was choroidal melanoma. Histologic specimens were available in six cases.
Results:
Scleral indentation posterior to the normal curvature of the globe was identified in 14 patients (58%). These patients had a mean tumour height of 4.4 mm (SD 2.0 mm) and mean tumour diameter of 9.5 mm (SD 2.9 mm). In the 10 patients with no scleral bowing the mean tumour height was 5.7 mm (SD 3.1 mm) and mean tumour diameter 11.5 mm (SD 3.8 mm). Pathological study (results available in nine cases in the scleral bowing group and four cases in the group without bowing) showed that all the tumours in the former group and three of those in the latter group were of the more indolent cell types, either mixed with predominantly spindle cells, or spindle cell. The six patients with histologic specimens were all in the scleral bowing group. The histologic features supported the ultrasound finding of posterior scleral bowing. No transscleral invasion occurred over the tumour region.
Interpretation:
Posterior bowing of the sclera at the tumour site was observed in over half of young patients with choroidal melanoma. This phenomenon can be detected by ultrasonography and has a different appearance from that of choroidal excavation.
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