Current approaches to the diagnosis and management of choroidal melanomas

Although malignant melanoma of the uveal tract is well known as the most common primary intraocular malignancy, many questions exist regarding the best approach to its diagnosis and treatment. In the past, diagnosis has been made by direct ophthalmoscopy alone and errors resulting in unnecessary enucleation have been frequent. However, recent studies have shown that the adequate use of new techniques such as indirect ophthalmoscopy, fluorescein angiography, ultrasonography, and the 32P test can reduce the incidence of error substantially. A 12-step procedure for diagnosis utilizing these aids is outlined. Traditionally, enucleation has been accepted as the treatment of choice. However, with earlier and more accurate diagnosis, alternative treatments are being applied in selected cases. Although photocoagulation, irradiation, cryotherapy, diathermy and local resection of choroidal melanomas have been used with some success, these methods require further trial and followup before their value can be established. Techniques and indications for use of these procedures are discussed, and the complications and potential effectiveness of each is evaluated.