A 50-year-old man with a known history of cutaneous melanoma presents with a unilateral exudative retinal detachment and a dome-shaped pigmented choroidal mass on B-scan ultrasonography. Ultrasound shows high initial spike followed by low internal reflectivity. The most likely diagnosis is:

• A Choroidal haemangioma
• B Uveal (choroidal) melanoma ✓
• C Choroidal osteoma
• D Choroidal metastasis from cutaneous melanoma

Explanation

Uveal melanoma is the most common primary intraocular malignant tumor in adults. B-scan ultrasound characteristically shows a dome or mushroom-shaped lesion with high initial spike (acoustic shadow from the surface) and low internal reflectivity due to homogeneous compact cells, with sound attenuation (choroidal excavation). This ultrasonographic pattern distinguishes it from choroidal metastasis (which tends to have high internal reflectivity) and haemangioma. The monosomy 3 chromosomal change correlates with metastatic potential.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.