Choroidal melanoma is the most common primary intraocular malignancy in adults, but is still quite rare with an incidence of about six per one million people. It most commonly presents in the sixth decade, but can affect individuals of any age. In most studied populations, there is a slight predisposition towards males.
The most common appearance is a pigmented, elevated choroidal lesion that will enlarge without treatment (Fig. 21.2.1 and Fig. 21.2.2). Without documented growth, features such as overlying lipofuscin (orange pigment), associated subretinal fluid, larger size, and proximity to the optic nerve help to differentiate from benign lesions such as choroidal nevus. On a clinical basis, the diagnosis can be made with greater than 99% accuracy. Biopsy is rarely necessary, but can confirm the diagnosis. Radiation retinopathy can often develop after treatment with external radiation (Fig 21.2.3).