Ocular melanoma most commonly arises from which uveal structure, and what is the most common site of metastasis?

• A Choroid; liver ✓
• B Iris; regional lymph nodes
• C Ciliary body; lungs
• D Retinal pigment epithelium; brain

Explanation

Uveal melanoma arises most commonly from the choroid (~90%), followed by ciliary body (~7%) and iris (~3%). Unlike cutaneous melanoma, uveal melanoma spreads exclusively haematogenously (no lymphatics in the uvea) with the liver being the primary metastatic site in up to 90% of patients with metastatic disease. The COMS (Collaborative Ocular Melanoma Study) compared enucleation versus brachytherapy for medium-sized tumors, showing equivalent survival rates.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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