Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Duke Elder: Finals Ophthalmology (Alice) > Choroidal melanoma > Flashcards

Choroidal melanoma Flashcards

(60 cards)

Start Studying
1
Q

Why is choroidal melanoma an important intraocular tumour to know about? 2 reasons

A
  1. Most common primary malignant intraocular tumour
  2. Second most common type of primary malignant melanoma in the body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What ethnic / regional groups are most affected by choroidal melanoma?

A

White people of Northern European descent (Denmark and other Scandinavian countries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In which part of the world is choroidal melanoma most common and what is the incidence here?

A

Denmark and other Scandinavnian countries: incidence about 7.5 cases / million / year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does choroidal melanoma affect the sexes differently?

A

Occurs more frequently in men for all age groups except 20-39, when a small predilection exists for women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which type of eyes does choroidal melanoma most commonly affect?

A

Light-coloured irides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the key, most likley contributor to the development of choroidal melanoma?

A

Sunlight exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 5 predisposing diseases for uveal melanomas?

A
  1. Family history of uveal melanoma
  2. Uveal naevus
  3. Congenital ocular melanocytosis
  4. Dysplastic naevus syndrome
  5. Xeroderma pigmentosum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common site of choroidal melanoma metastasis?

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 distinct cell types recognised in uveal melanomas?

A
  1. Spindle A: elongated nuclei, uncommonly have mitotic figures
  2. Spindle B: prominent nucleolus
  3. Epithelioid: anaplastic (unspecialised), poorly cohesive, considerable morphologic variation; resemble epithelial cells, contain frequent mitotic figures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the presentation of symptoms often like in choroidal melanoma, and how therefore are they often detected?

A

Often remain asymptomatic for prolonged period, may be found incidentally during ophthalmoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 5 symptoms specific to choroidal melanoma (rather than relating to metastasis)?

A
  1. Blurred visual acuity
  2. Paracentral scotoma
  3. Painless and progressive visual field loss
  4. Floaters
  5. Severe ocular pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 4 symptoms that could suggest a primary non-ocular malignancy with choroidal metastasis?

A
  1. Weight loss
  2. Marked fatigue
  3. Cough
  4. Change in bowel or bladder habits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are 3 infrequent presentations of advanced choroidal melanoma?

A
  1. Painful blind eye
  2. Cataract
  3. Proptosis from tumour transscleral orbital extension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

From which examination technique may choroidal melanoma be found incidentally, due to remaining asymptomatic for long periods?

A

Ophthalmoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What factor increases the delay of symptoms of choroidal melanoma?

A

The more anterior the origin, the longer delay of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is shown in the image?

A

Choroidal melanoma (see another pic showing dome-shaped choroidal melanoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the physical appearance of small choroidal melanomas?

A

Nodular, dome-shaped and well-circumscribed mass under the retinal pigment epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do choroidal melanomas appear as they grow? 3 key things

A
  • May adopt more irregular configurations e.g. bilobular, multilobular, mushroom shapes.
  • May become diffuse choroidal melanoma.
  • Variable colouration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is diffuse choroidal melanoma?

A

Lateral growth of melanoma throughout choroid with minimal elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe what is meant by variable colouration of choroidal melanomas.

A
  • Amelanotic to darkly pigmented, some partially pigmented.
  • If light coloured, vascularisation usually can be seen ophthalmoscopically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of changes usually overlie choroidal melanomas? Give 3 examples

A

Retinal pigment epithelial changes e.g.:

  1. Drusen
  2. Patches of atrophy
  3. Orange discolouration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 3 types of ocular conditions that a choroidal melanoma could remain under?

A
  1. Large exudative retinal detachment
  2. Subretinal haemorrhage
  3. Vitreous haemorrhages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What type of vascular changes may be associated with choroidal melanoma?

A

May show sentinel vessels: dilated episcleral blood vessels vissible through conjunctiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What type of changes in choroidal melanoma may mean there are visible areas of abnormal hyperpigmentation with the naked eye?

A

Episcleral growth: subconjunctival area of hyperpigmentation (pic shows enucleated eye with this)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are 5 key investigations to perform in suspected choroidal melanoma?
1. LFTs 2. Ultrasound 3. Angiography 4. Imaging studies 5. Biopsy
26
Why should you perform LFTs in suspected choroidal melanoma?
Liver most common site of choroidal melanoma metastasis
27
What are 4 key things to look at in LFTs performed in suspected choroidal melanoma?
1. ALP (alkaline phosphatase) 2. Glutamic-oxaloacetic transaminase 3. LDH (lactage dehydrogenase) 4. Gamma-GT (gamma-glutamyl transpeptidase)
28
What type of choroidal melanomas is ultrasound useful for?
tumours thicker than 2-3mm
29
What can ultrasound be used for in choroidal melanoma?
Can use this to evaluate **extaocular extension**, establish tumour **size** and plan **intervention**
30
What does ultrasound characteristically show for choroidal melanomas?
* An initial prominent **spike**, **excavation** of underlying uveal tissue, internal **vascularity** * (acoustically quiet at one base due to acoustic shadowing)
31
What 2 typea of angiography are used for suspected choroidal melanoma?
FFA and indocyanine green angiography
32
What is the benefit of performing angiography in suspected choroidal melanoma?
Don't show pathognomonic signs of choroidal melanoma but can help point to its diagnosis
33
What are 3 types of imaging studies that may be useful in suspected choroidal melanoma?
1. Chest x-ray to rule out lung mets 2. CT 3. MRI of globe and orbit
34
What is the purpose of performing a CT in suspected choroidal melanoma?
to visualise **extra-ocular extension** + differentiate between **choroidal or retinal detachment** and solid tumour
35
What is the purpose of an MRI of the globe and orbit in suspected choroidal melanoma?
To determine **extrascleral extension** of melanoma and distinguish the surrounding **fluid** from the tumour
36
What are 2 types of biopsy that can be done in suspected choroidal melanoma?
1. Fine needle biopsy 2. Incisional biopsy
37
When might a biopsy be required in suspected choroidal melanoma?
Not usually required but may be useful in difficult diagnostic cases, and where other tests equivocal
38
What is fine needle biopsy being increasingly used for in suspected choroidal melanoma?
Prognostic purposes
39
What has often occurred by the time a patient with choroidal melanoma is diagnosed?
Posterior uveal melanomas have already spread through micrometastasis
40
What are 7 factors to take into account when considering the management of choroidal melanoma?
1. Visual acuity of affected eye 2. Visual acuity of contralateral eye 3. Size of tumour 4. Age 5. General health 6. Ocular structures involved 7. Presence of metastatses
41
What are 8 possible management options for choroidal melanoma?
1. Observation 2. Immunotherapy and targeted therapy 3. Enucleation 4. Plaque brachytherapy 5. External beam irradiation pars plana vitrectomy endoresection 6. Block excision 7. Laser photocoagulation and transpupillary thermotherapy 8. Orbital exenteration
42
When might observation be an acceptable management approach for choroidal melanoma?
For posterior uveal tumours where diagnosis is not well-established; if \<2-2.5mm and 10mm in diameter, observe until growth documented
43
What does observation as a management option for choroidal melanoma actually mean?
Observe until growth documented: **photography** and **sequential US** for measuring precise dimensions
44
What is the management of metastatic choroidal melanoma?
Immunotherapy and targeted therapy
45
What are the 2 key groups of immunotherapy/ targeted therapy for metastatic choroidal melanoma, and which mutations are they used for?
1. Oral **BRAF** inhibitors: dabrafenib (tafinlar) and vemurafenib (Zelboraf) for mutated BRAF gene 2. Oral **MEK** inhibitors if BRAFV600E or V600K mutation
46
How are different types of immunotherapy for choroidal melanoma usually given?
Oral MEK and BRAF inhibitors usually given in combination
47
What are 2 further types of immunotherapy/targeted therapy for choroidal melanoma currently under investigation?
1. KIT inhibitors (in clinical trials) 2. Tumour-infiltrating lympocyte (TIL)
48
What is enucleation and when is it used?
removal of the eye. It is the classic approach for *_large and complicated tumours_*, especially if **vision affected**
49
What is the classic treatment for large and complicated choroidal melanomas?
Enucleation
50
What is plaque brachytherapy as a treatment for choroidal melanoma?
Uses plaques containing various radioactive isotopes (iridium, cobalt, ruthenium); radiation causes tumour destruction through damage of DNA
51
What type of choroidal melanoma is plaque brachytherapy used to treat?
medium-sized posterior uveal melanoma
52
What radioactive isotope is most commonly used for plaque brachytherapy?
Iodine-125
53
What is a risk associated with plaque brachytherapy?
Risk of iris and anterior chamber angle neovascularisation
54
What type of choroidal melanomas is block excision used for?
Reserved for small tumours
55
What is orbital exenteration and when is it used as a treatment in choroidal melanoma?
* Surgical removal of eyeball and surrounding tissues: eyelids, muscles, nerves, fat * Used if extraocular local spread
56
Is there effective treatment in existence for metastatic uveal melnaoma?
No
57
What is the 10-year mortality post-diagnosis of choroidal melanoma?
30-50% (high mortality)
58
What is usually the cause of death from choroidal melanoma?
Due to secondary metastases
59
What are 7 features of choroidal melanomas that correlate with increased mortality?
1. **Larger size** 2. **Anterior** location 3. Transscleral extension 4. Growth through Bruch membrane 5. Optic nerve extension 6. **Lack of pigmentation** 7. Mitotic activity and cell type
60
What is usually the result of the primary choroidal melanoma?
Partial or total visual loss in affected eye, due to tumour or treatment

Duke Elder: Finals Ophthalmology (Alice) (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions