Ocular Oncology and Pathology
Core concepts
Know the intraocular tumors: uveal melanoma (choroidal, iris, ciliary body), retinoblastoma (leukocoria, calcification, RB1 gene), and metastasis (most common intraocular malignancy in adults). Understand retinoblastoma staging and treatment (enucleation, chemotherapy, focal therapy). Know conjunctival tumors (SCC, melanoma, OSSN) and eyelid tumors (basal cell carcinoma most common, sebaceous carcinoma masquerading as blepharitis). Understand histopathology basics: spindle vs. epithelioid melanoma cells, and the role of biopsy.
Traps
A classic trap is sebaceous carcinoma misdiagnosed as chronic blepharoconjunctivitis - suspect in older patients with recurrent chalazion. Another is retinoblastoma vs. Coats disease - both cause leukocoria, but retinoblastoma has calcification and family history. Also know choroidal nevus vs. melanoma (thickness, subretinal fluid, orange pigment).
Worked example
A 2-year-old with leukocoria and a calcified intraocular mass. Rule of thumb: leukocoria + calcification = retinoblastoma; obtain imaging, genetic counseling, and refer to oncology.