Ocular Oncology and Pathology
Core concepts
Know the common ocular tumours: uveal melanoma (choroidal, iris, ciliary body), retinoblastoma (children, leukocoria), lymphoma (masquerade), and conjunctival lesions (SCC, melanoma, naevus). Understand the difference between benign and malignant features: size, growth, vascularity, and systemic associations.
Learn the pathology principles: histology of melanoma (spindle vs epithelioid), retinoblastoma (Flexner-Wintersteiner rosettes), and the role of biopsy versus clinical diagnosis. Know the staging and the risk of metastasis in uveal melanoma (liver).
Traps
- Missing retinoblastoma in a child with leukocoria.
- Confusing a choroidal naevus with melanoma (growth, symptoms, imaging).
- Overlooking lymphoma in a patient with chronic uveitis.
- Not recognising conjunctival melanoma as a distinct entity from naevus.
Rule of thumb
Any pigmented choroidal lesion that grows or causes symptoms should be treated as melanoma until proven otherwise; and leukocoria in a child requires urgent oncology assessment.
Worked example
A 60-year-old with a pigmented choroidal mass, subretinal fluid, and decreased vision. Ultrasound shows a dome-shaped lesion with low internal reflectivity, consistent with uveal melanoma; staging includes liver imaging.