Issues in the diagnosis and management of small choroidal melanocytic lesions

Uveal melanoma is the most common primary intraocular malignancy in adults. It is generally accepted that most, if not all, choroidal melanomas arise from benign nevi, and an important diagnostic problem is differentiating a large choroidal nevus from an early malignant melanoma. Clinical features suggestive of malignancy and clinical factors predictive of tumor growth and metastasis have been identified. Although large and medium choroidal melanomas are generally treated with enucleation or radiotherapy, there is no consensus concerning whether treatment other than serial observation is indicated for small choroidal melanocytic lesions. A randomized controlled clinical trial is needed to assist in determining optimal management of small choroidal melanomas.