Posterior Segment
Choroidal Melanoma
Also known as: choroidal melanoma, ocular melanoma, uveal melanoma, pigmented choroidal mass, suspicious choroidal lesion, orange pigment, subretinal fluid
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Choroidal melanoma is a potentially life-threatening intraocular malignancy. Optometry role is detection of suspicious choroidal mass features, careful documentation, and prompt referral (within 2 weeks) to ocular oncology or retinal specialist pathways. Do not reassure a suspicious lesion as a naevus without risk assessment.
Recognition
Symptoms: what patients report
- May be asymptomatic and found incidentally.
- Blur, visual field defect, flashes, floaters, or distortion may occur depending on location and associated fluid.
- Symptoms are one of the risk factors the Centre for Eye Health chair-side reference lists; a lesion without symptoms is not low risk on that account.
Signs: what the examination shows
- Elevated pigmented choroidal mass.
- Orange pigment, subretinal fluid, or associated retinal detachment may be present.
- Document lesion size, thickness if available, margins, symptoms, and proximity to optic disc or fovea.
- Risk features (TFSOM-DIM): thickness more than 2 mm, diameter more than 5 mm, subretinal fluid, symptoms, orange pigment, and acoustic hollowness on ultrasound. A mushroom or dome shape on B-scan indicates extension through Bruch's membrane (Centre for Eye Health chair-side reference).
What OptoGuide™ covers for choroidal melanoma
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked New Zealand therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Choroidal and Ciliary Body Melanoma — EyeWiki
- The Differential Diagnosis of Posterior Uveal Melanoma. Shields JA, Augsburger JJ, Brown GC, Stephens RF. Ophthalmology. 1980;87(6):518-22.
- Choroidal Melanoma: Clinical Features, Classification, and Top 10 Pseudomelanomas. Shields CL, Manalac J, Das C, Ferguson K, Shields JA. Current Opinion in Ophthalmology. 2014;25(3):177-85.
- Peripheral Exudative Hemorrhagic Chorioretinopathy Simulating Choroidal Melanoma in 173 Eyes. Shields CL, Salazar PF, Mashayekhi A, Shields JA. Ophthalmology. 2009;116(3):529-35.
- Optometry Australia — A Diagnostic Guide to Posterior Eye Disease, Chairside Reference Pack (Centre for Eye Health), Version 2.0, 2026: Pigmented Posterior Lesions
- College of Optometrists — Clinical Management Guideline: Pigmented fundus lesions (updated 20 May 2025).
- Small choroidal melanoma: detection with multimodal imaging and management with plaque radiotherapy or AU-011 nanoparticle therapy. Shields CL, Lim LS, Dalvin LA, et al. Current Opinion in Ophthalmology. 2019;30(3):206-214.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.