Subretinal Exudation: The First Presentation of Untreated Choroidal Melanomas

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Choroidal melanoma is a rare intraocular malignancy.
• Subretinal exudation is an atypical clinical manifestation in choroidal melanoma.
• Early diagnosis and risk stratification are crucial for managing choroidal melanoma.

Purpose of the Study:

• To report on the unusual clinical presentation of subretinal exudation in patients with untreated choroidal melanoma.
• To analyze the demographic, clinical, and imaging features of these cases.
• To investigate the potential prognostic significance of subretinal exudates in choroidal melanoma.

Main Methods:

• Case series analysis of 886 patients with primary choroidal melanoma.
• Screening of fundus photographs for lipid exudates by two independent experts.
• Analysis of patient demographics, clinical manifestations, imaging features (OCT, ultrasound), and histopathological/genetic results.

Main Results:

• Eight cases (0.90%) of subretinal exudates were identified in patients with choroidal melanoma.
• Mean age of affected patients was 51 years; no gender predilection.
• Optical coherence tomography (OCT) confirmed subretinal fluid and exudates; ultrasound showed low/medium internal reflectivity in most cases.
• Biopsy analysis in four cases revealed low-risk spindle cell choroidal melanoma with disomy 3.

Conclusions:

• Subretinal lipid exudates are an atypical finding in choroidal melanoma.
• The subretinal location of exudates can aid in differentiating from other retinal vascular conditions.
• Cytogenetic analysis in these cases indicated a low metastatic risk, suggesting exudates may be a positive prognostic sign.