Choroidal Melanoma MCQ — NEET PG Practice Question | NEETPGAI
Choroidal Melanoma
medium
eye Ophthalmology
A 62-year-old man with fair skin and light-colored irises presents with blurred vision in his right eye. Dilated fundoscopy reveals a pigmented intraocular mass. The structure marked **A** in the diagram shows a mushroom-shaped configuration with rupture of Bruch membrane and extension into the subretinal space. Which of the following statements best characterizes this lesion?
A. It is a retinal pigment epithelium hamartoma associated with neurofibromatosis type 1
B. It is the most common primary intraocular malignancy in adults, arising from melanocytes of the uveal tract
C. It is a benign choroidal nevus that requires no treatment or surveillance
D. It is a metastatic lesion from cutaneous melanoma and carries the same prognosis as systemic disease
Explanation
Why "It is the most common primary intraocular malignancy in adults, arising from melanocytes of the uveal tract" is right
The mushroom-shaped configuration with Bruch membrane rupture shown at A is pathognomonic for choroidal melanoma. According to the COMS reports and AAO BCSC Ophthalmic Pathology 2024, choroidal melanoma is the most common primary intraocular malignancy in adults, arising from melanocytes of the uveal tract (90% choroid, 7% ciliary body, 3% iris). The mushroom or collar-button configuration reflects tumor breakthrough of Bruch membrane with extension into the subretinal space—the exact finding depicted at A. The patient's risk factors (fair skin, light irises) further support this diagnosis.
Why each distractor is wrong
It is a benign choroidal nevus that requires no treatment or surveillance: While choroidal nevi are common and benign, the mushroom-shaped configuration with Bruch membrane rupture is a high-risk feature that distinguishes melanoma from nevus. The TFSOM-UHHD mnemonic identifies this morphology as a red flag for malignancy.
It is a metastatic lesion from cutaneous melanoma and carries the same prognosis as systemic disease: Choroidal melanoma is a primary intraocular malignancy, not a metastatic lesion. Although it can metastasize hematogenously (predominantly to liver), the lesion shown at A represents the primary tumor. The prognosis is determined by COMS size classification and cytogenetic features, not by cutaneous melanoma status.
It is a retinal pigment epithelium hamartoma associated with neurofibromatosis type 1: RPE hamartomas are benign lesions associated with NF1 and lack the mushroom-shaped morphology and Bruch membrane rupture. The lesion at A is a malignant melanocytic tumor, not a hamartoma.
High-YieldNEET PG
Mushroom-shaped choroidal mass with Bruch membrane rupture = choroidal melanoma until proven otherwise; COMS size classification (small <3 mm, medium 3–8 mm, large >8 mm) guides treatment.
COMS reports; AAO BCSC Ophthalmic Pathology 2024
Practice similar questions
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.
