CLINICALLY UNEXPECTED MALIGNANT-MELANOMA OF THE UVEA, 1981-1995, IN THE OPHTHALMOPATHOLOGIC LAB IN ERLANGEN

Purpose The aim of this study was to investigate the incidence of unex pected malignant uveal melanoma in the age of ultrasound diagnostics a nd to highlight the reasons for misdiagnosis. Patients and methods All eyes were surgically removed and histologic examination was performed between 1981 and 1995, The eyes were investigated for the incidence o f uveal melanoma, and the history of the unexpected malignant melanoma of the uvea or ciliary body highlighted. Results 225 (18,7%) eyes wit h malignant melanoma out of 2583 enucleated eyes were found. Eight (3. 6%) of 225 were clinically unexpected. The clinical misdiagnoses were secondary angle closure or open angle glaucoma (6), retinal detachment (5), iritis (1), scleritis (1), cataract (4) and an intraocular mass that was believed to be a metastasis of a colon carcinoma. Seven of ei ght eyes were blind, and one eye had light perception only. The longes t follow up before enucleation was 13 years, On three eyes diagnostic ultrasound was reportedly performed without specific diagnosis of uvea l melanoma. Surgery was performed on four eyes for reasons of uncontro llable intraocular pressure or retinal detachment up to five years bef ore enucleation. Histologic diagnoses were 3 epitheloid-type. 2 spinde l-type and 3 necrotic melanoma of the uvea. Four eves showed scleral i nvasion by tumor cells and one eye an invasion into the episcleral spa ce. Conclusions Even today the rate of unexpected uveal melanoma, acco rding to our study is 3,6%. Therefore, all blind eyes without visualis ation of the posterior pole should be examined with ultrasound in orde r to diagnose an uveal melanoma prior to enucleation.