A 60-year-old man is found to have a pigmented choroidal tumour measuring 12 mm in basal diameter and 4 mm in thickness, confirmed by ultrasonography with low internal reflectivity. There is no evidence of metastasis. What is the preferred treatment according to established trial data?

• A Plaque radiotherapy (brachytherapy) ✓
• B Enucleation of the eye
• C External beam radiotherapy alone
• D Observation with six-monthly fundus photography

Explanation

Medium-sized choroidal melanomas, defined in the Collaborative Ocular Melanoma Study as 2.5 to 10 mm thickness and up to 16 mm basal diameter, are managed with iodine-125 episcleral plaque brachytherapy, which achieves survival rates comparable to enucleation while preserving the eye. Enucleation is reserved for large tumours exceeding these dimensions. Observation is inappropriate because growth and metastasis risk have been documented, and external beam radiotherapy alone delivers inadequate tumour control compared with plaque therapy.

Reference: AAO Basic and Clinical Science Course, Section 12: Retina and Vitreous, Recent edition ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.