Pseudomelanoma at a Referral Center in Iran

Purpose: To report the diagnoses of lesions initially misdiagnosed as ocular melanoma. Methods: This retrospective study included all new patients who were referred with a presumptive diagnosis of choroidal melanoma to the ocular oncology clinic at Farabi Eye Hospital from January 2009 to December 2012. Each patient underwent a full ocular examination and B-scan ultrasonography by an ocular oncologist. The final diagnosis was made based on a combination of clinical features, fluorescein angiography, indocyanine green angiography, optical coherence tomography, neuroimaging and biopsy when necessary. Results: Out of a total of 194 patients referred with a preliminary diagnosis of choroidal melanoma, 73 (37.6%) subjects actually had pseudomelanoma. Mean age in this subgroup was 46.5±23.1 (range, 1.5-85) years. The most common entities simulating a choroidal melanoma were vasoproliferative tumors (12 cases), choroidal metastasis (11 cases), peripheral exudative hemorrhagic chorioretinopathy (10 cases), lymphoproliferative infiltrative lesions (6 cases) and melanocytoma (5 cases). Conclusion: A wide range of lesions may mimic ocular melanoma; a correct diagnosis may be made by a combination of clinical examination and imaging modalities.