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From questions on page 632

  1. What investigations would you perform at this stage?

    Liver and abdominal ultrasound and MRI showed no tumour deposits. The orbit was assessed with CT (figure 3A) and MRI scans (figure 3B) to define the relationship between the lesion and the orbital walls. A large mass was seen medial and superior to the globe and in direct contact with the orbital roof. The lower fornix satellite lesion was excised under local anaesthetic. Histology demonstrated uveal melanoma of spindle cell type. Closed vascular loops were present, comparable with the resection specimen from 1977.

  2. What is the prognosis?

    Prognostication in uveal melanoma remains unpredictable. Large tumour size, extrascleral extension and closed vascular loops have been associated with metastases, whereas low mitotic rate, spindle cell morphology and normal chromosomes 3 …

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