ABSTRACT
The most frequent primary intraocular tumour is choroidal melanoma. Tumours arising in the choroid have a 30 per cent chance of metastasis at 5 years while rarer iris or conjunctival melanomas have a much lower risk. Tumour size is the most important prognostic factor. Small melanomas are usually asymptomatic and can be difficult to differentiate from various benign conditions. Small tumours ( 5 mm diameter and 3 mm thick) can therefore be observed or treated with iodine-125 or ruthenium-106 plaque brachytherapy, protons or other local treatments such as laser photocoagulation or surgical excision. Large tumours (16 mm diameter or 10 mm thick) are treated with enucleation. Preoperative radiation does not improve cure rates. Where there is extrascleral extension, prognosis is poor but enucleation and postoperative radiotherapy can be considered to optimise local control.
