The management of small choroidal melanomas

There are a number of unresolved questions regarding small choroidal melanomas. At what stage in the natural history of these tumors do they develop the capacity to metastasize? What are the effects of various therapeutic modalities on the incidence of metastatic disease? Clinicopathologic studies suggest that patients with small choroidal melanomas (less than 10 mm in diameter and 3 mm in height) have an excellent prognosis. In patients with small choroidal melanomas with clear ocular media and no clinical retinal detachment, it is reasonable to do serial examinations without therapeutic intervention until growth is documented. In patients with small choroidal melanomas in which growth is documented, enucleation or alternate modes of therapy, including photocoagulation or radiation, are reasonable methods of treatment. Only by conducting prospective studies can we obtain a better understanding of the natural history of choroidal melanomas, determine at what stage these small lesions develop a metastatic potential, and evaluate the relative efficacy of various treatment modalities in preventing the development of metastatic disease.