The Small Choroidal Melanoma: Diagnosis, Treatment Outcomes, and Unending Controversy

PurposeSmall choroidal melanoma (SCM) remains a diagnostic challenge due to its clinical overlap with choroidal nevus. This overlap encompasses a wide clinical phenotype of lesions termed indeterminate choroidal lesions. Treating an indeterminate lesion is weighed against significant visual morbidity from local treatment versus increased metastatic risk with tumor size.MethodsThis comprehensive review includes diagnosis, controversies, management, and future therapy options for small choroidal melanoma.ResultsFor diagnostically challenging cases, indeterminate choroidal lesions can be closely monitored for growth utilizing multimodal imaging. Tumor biopsies can be performed for either diagnostic purposes in indeterminate choroidal lesions or for metastatic risk prognostication in small choroidal melanomas. Several new treatment options exist to reduce the risk of radiation complications.ConclusionDespite significant advances in diagnostic imaging, molecular analysis, and treatment techniques for SCM, these tumors may still pose a challenge on appropriate timing and management options.