The management of choroidal tumors

TWe have outlined a systematic approach to the management of choroidal lesions which might appear to be choroidal melanoma: 1. When a solid, elevated mass is suspected of being a malignancy, first complete a thorough examination of both eyes, including a detailed history. Arrange for a general medical evaluation to detect sources of metastatic lesions or early metastases from the eye. 2. Eliminate the possibility of flat choroidal lesions by slit-lamp and indirect ophthalmoscopic examination. These are considered benign and can be followed at routine intervals with simple sketches or color fundus photographs. Fluorescein angiography is not essential, but can confirm the benign appearance and help in following overlying secondary changes such as pigment epithelial defects. 3. Rule out serous or cystic lesions by the use of slit lamp and fundus contact lens, and indirect ophthalmoscope with transillumination. Fluorescein angiography again can help confirm the benign nature of these lesions, but the serial fundus examinations are definitive in 99 percent cases. 4. Document the appearance of the lesion with drawings, stereo-photographs, and stereo angiography. Follow the evolution of the lesion with these modalities for a sufficient time to be certain of the diagnosis. 5. Follow lesions in the peripapillary area with particular care.