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Detection of uveal melanoma

Many asymptomatic tumours are detected as a result of routine screening, for example, performing bilateral ophthalmoscopy when the patient has presented for new spectacles.However, it is not uncommon for patients to present with a symptomatic choroidal tumour soon after having an eye examination, suggesting perhaps that the ophthalmoscopy was limited to optic disc and macula.

 

A significant proportion of patients with uveal melanoma report that their tumour was not detected when they first presented on account of symptoms. We have found statistically that in comparison with symptomatic patients whose tumour was immediately detected, such individuals experience longer delays in obtaining treatment and are also more likely to lose vision and the eye.

 

A mnemonic, MELANOMA, has been devised to help remember the symptoms and external signs that might indicate the presence of a uveal melanoma. Of course, some of these features are not specific to melanoma, or indeed to any tumour, and some can be caused by other pathology.

The features suggestive of uveal melanoma, include:

M     Melanoma visible externally, as extraocular extension, an iris tumour or iris heterochromia
E Eccentric visual phenomena, such as field loss and photopsia, caused by tumour or secondary detachment
L Lens abnormalities, such as astigmatism and cataract, caused by a ciliary body tumour
A Afferent pupillary defect, caused by tumour or retinal detachment
N No optical correction, because of blurring or metamorphopsia from macular oedema, retinal detachment or tumour
O Ocular hypertension from rubeosis iridis or tumour cells or macrophages in the angle
M Melanosis oculi (naevus of Ota)
A Asymmetrical episcleral vessels, indicating a ciliary body tumour