Close examination by an experienced clinician remains the most important diagnostic approach for uveal melanoma detection. It is very hard to distinguish a small uveal melanoma from a nevus. The routine examination of the latter is often important to observe if it is growing. Clinical findings that help to identify uveal melanoma are:
- A lesion thickness of more than 2 mm.
- Subretinal fluid.
- Visual signs and symptoms (link).
- An orange-pigmented tumour surface.
- A tumour margin touching the optic disc.
There are several tests, important for the diagnosis of uveal melanoma, such as:
- An eye examination;
- Ultrasound scan of the eye;
- Angiogram or a fluorescein angiogram: this exam allows us to look at blood vessels using a type of dye. This will help physicians find out more about the nature of the tumour;
- Fine needle aspiration biopsy: this is a rarely used exam because the above listed tests are usually accurate in the diagnosis; however, this one is important for tumour staging and determining risk of metastasis upon genetic testing of the sample as below.
- Testing genetic information in the cells: this is known as cytogenetic testing. It helps to provide the doctor with information about the possibilities of the cancer coming back or spreading. At the moment, the tumour genetics often don’t affect directly the treatment of the eye tumour, but this information is crucial to determine risk of the disease's recurrence in the future.
- Other tests include exams to evaluate general health.
- Ultrasound or MRI scans of the liver: these exams are important since uveal melanoma has a risk of spreading to the liver. Which methods are best for these exams is still under debate, and may depend on details of the method and specialisation of the physicians involved.
It is debated which exam(s) are best suited for diagnosis - and with which frequency they should be taken; future research should help us establish the evidence for these guidelines.
If an ophthalmologist suspects uveal melanoma, an eye cancer specialist should be notified.
Patients may need to wait a while to get the results. Comprehensibly, this can be a very anxious period of time for most people. Access patient networks and other resources for organisations that can put patients and families in touch with support groups and provide further information.