Ocular Oncology and Pathology
Core concepts
Know intraocular tumors: uveal melanoma (most common primary intraocular malignancy in adults; risk of metastasis to liver), retinoblastoma (most common intraocular malignancy in children; leukocoria, calcification), and choroidal nevus versus melanoma. Understand conjunctival tumors: squamous cell carcinoma, melanoma, and lymphoma. Know the pathology of common lesions: pinguecula, pterygium, and conjunctival intraepithelial neoplasia. Master the signs of malignancy: growth, vascularity, and atypical cells. Know that retinoblastoma has a genetic form (RB1 mutation) with bilateral disease and risk of second tumors.
Traps
Questions test that uveal melanoma metastasizes to the liver, not the lung, and that retinoblastoma is the most common childhood intraocular tumor. Another trap: distinguishing a choroidal nevus (flat, drusen, no growth) from melanoma (thickness, subretinal fluid, growth).
Worked example / rule of thumb
A 60-year-old has a pigmented choroidal lesion with subretinal fluid and growth over 6 months. That is suspicious for melanoma; obtain ultrasound and consider biopsy or treatment. Rule of thumb: growth plus subretinal fluid equals melanoma until proven otherwise.