The early detection of
malignancy, particularly
uveal melanoma, is crucial in protecting visual acuity, salvaging the eye, and preventing
metastasis. Risk factors for early detection of
uveal melanoma have been clearly delineated in the literature and allow identification of
melanoma when it is tiny and simulates a
nevus. These factors include thickness >2 mm, presence of subretinal fluid (SRF), symptoms, the orange pigment, margin near optic disc, acoustic hollowness, surrounding halo, and absence of drusen. The importance of early detection is realized when one considers
melanoma thickness, as each millimeter increase in
melanoma thickness imparts 5% increased risk for metastatic disease. Newer imaging modalities like enhanced depth imaging optical coherence tomography and fundus autoflouroscence facilitate in detection of SRF and orange pigment. Additional molecular
biomarkers and cytological features have been identified which can predict the clinical behavior of a small melanocytic lesion. Features that suggest a poor prognosis include higher blood levels of
tyrosinase m-
RNA,
vascular endothelial growth factor,
insulin-like growth factor;
monosomy 3 and gains in chromosome 8. Management of
uveal melanoma includes enucleation (for large), local eye wall resection,
brachytherapy, charged particle irradiation, and
thermotherapy (for small to medium
tumors). Although the role of a good clinical evaluation cannot be underestimated, it is advisable to evaluate the various radiological, molecular, and cytological features, to enhance the accuracy of early diagnosis and improved prognosis.