The differential diagnosis of posterior uveal melanoma

Two large studies from the Armed Forces Institute of Pathology (AFIP) have listed the various lesions which may clinically resemble malignant melanomas of the posterior uvea (pseudomelanomas). The studies from the AFIP were based upon histologic examination of eyes which were enucleated. The present study reports on 400 consecutive patients who were referred but who proved, by clinical evaluation, rather than by enucleation, to have a pseudomelanoma. Although about 40 different conditions were found to simulate melanoma, the more commonly encountered ones included suspicious choroidal nevus (26.5%), disciform degeneration (12.5%), peripheral disciform degeneration (11%), congenital hypertrophy of the retinal pigment epithelium (9.5%), and choroidal hemangioma (8%). The authors believe that this series provides the clinician with a differential diagnosis for posterior uveal melanomas which accurately reflects the clinical problem confronting ophthalmologists today.