Related Experiment Video
Updated: Aug 16, 2026
Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography
Published on: December 2, 2022
Pseudomelanomas of the posterior uveal tract: the 2006 Taylor R. Smith Lecture
Jerry A Shields1, Arman Mashayekhi, Seong Ra
1Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. jerry.shields@shieldsoncology.com
Purpose:
To determine the types and frequency of lesions that clinically simulate choroidal or ciliary body melanoma (posterior uveal melanoma; PUM).
Patients And Methods:
A review was conducted on cases of patients referred to the ocular oncology service from October 1978 through September 2003 with the diagnosis of possible PUM but who were subsequently diagnosed by the authors to have a simulating lesion rather than PUM. The type and percent of pseudomelanomas were tabulated and compared with findings of a similar study from our service on data collected before 1978.
Results:
There were approximately 12,000 patients referred because of a lesion believed to be a PUM during the 25 years included in the data collection. Of these patients, 1,739 (14%) were found to have a simulating condition. There were 54 different conditions that simulated melanoma. The most frequent condition was choroidal nevus, accounting for 851 cases (49%) of the pseudomelanomas. This was followed by peripheral exudative hemorrhagic chorioretinopathy (139 cases; 8%), congenital hypertrophy of the retinal pigment epithelium (108 cases; 6%), hemorrhagic detachment of the retina or pigment epithelium (86 cases; 5%), circumscribed choroidal hemangioma (79 cases; 5%) and age-related macular degeneration (76 cases; 4%). Compared with the 1980 report, the rate of pseudomelanomas diagnosed as choroidal nevus increased from 26% to 49%.
Conclusion:
A variety of lesions can simulate PUM. Suspicious choroidal nevus is still the lesion most difficult to differentiate from PUM. Most other pseudomelanomas account for a lower percent compared with findings from the prior study, suggesting that clinicians are now more familiar with the other pseudomelanomas and less likely to refer them to rule out PUM.
Insights
Choroidal nevus is the most common condition mimicking posterior uveal melanoma (PUM). Increased clinician familiarity with other PUM simulators has reduced their referral rates.
Area of Science:
- Ophthalmology
- Oncology
- Medical Imaging
Background:
- Posterior uveal melanoma (PUM) is a rare intraocular malignancy.
- Accurate diagnosis is crucial for appropriate patient management.
- Various benign lesions can mimic PUM, leading to diagnostic challenges.
Purpose of the Study:
- To identify and quantify the types and frequencies of lesions that clinically simulate PUM.
- To compare current findings with historical data to assess changes in diagnostic patterns.
Main Methods:
- Retrospective review of 1,739 patients diagnosed with simulating lesions instead of PUM.
- Data collected over a 25-year period (1978-2003) from an ocular oncology service.
- Comparison with a previous study conducted before 1978.
Main Results:
- 54 different conditions simulated PUM, with choroidal nevus being the most frequent (49%).
- Other common simulators included peripheral exudative hemorrhagic chorioretinopathy (8%) and congenital hypertrophy of the retinal pigment epithelium (6%).
- The proportion of choroidal nevi diagnosed as pseudomelanoma increased significantly from 26% to 49% compared to the earlier study.
Conclusions:
- A diverse range of lesions can mimic PUM.
- Choroidal nevi remain the most challenging lesions to differentiate from PUM.
- Increased clinician awareness of other PUM simulators may explain their decreased relative frequency in referrals.
