Symptoms · early detection · diagnosis

Uveal melanoma: symptoms and how it is detected

Uveal melanoma may cause no symptoms for a long time. It helps to know which changes deserve an eye examination and how an ophthalmologist confirms or rules out a suspicious lesion.

For patients and clinicians

Important

You cannot see every ocular melanoma in a mirror

Choroidal and ciliary-body tumours are inside the eye. There is no widely recommended population screening test for average-risk adults, but some tumours are detected during routine eye examinations.

What a person may notice

Visual changeblurred or distorted vision, or loss of part of the visual field

Floaters or flashesnew floaters or photopsias can justify an eye examination

A spot on the irisespecially if a pigmented area enlarges or changes

Pupil changenew asymmetry or a change in shape or position

Painpain is uncommon and is more often associated with extensive local disease

There may be no symptomsESMO 2026: 13–30% are diagnosed during routine eye examinations

These symptoms are not specific to cancer. They are much more often caused by other conditions. Their role is to prompt an ophthalmic examination, not to establish a diagnosis by self-inspection.

How diagnosis is established

Multimodal assessment - not one test

1Ophthalmic examination

Visual acuity, slit-lamp examination, dilated pupil and fundus examination.

2Fundus photography

Documents size, colour, location and change over time.

3Ocular ultrasound

B-scan assesses shape, thickness and internal reflectivity; ESMO recommends high-frequency UBM for ciliary-body lesions.

4OCT / FAF / angiography

Can show subretinal fluid, orange pigment and other features when clinically relevant.

5Orbital MRI / systemic staging

Used to evaluate local extent and, after diagnosis, to investigate metastatic disease when indicated.

6Biopsy is not automatic

A typical lesion is often diagnosed clinically. Biopsy is discussed for diagnostic uncertainty and/or prognostic molecular profiling.

Real clinical images

How iris melanoma can look

Not every melanoma is dark and not every lesion has the same morphology.

Eight clinical photographs showing different morphologies of iris melanoma — **Eight real iris melanoma morphologies:** weakly pigmented, dome-shaped, nodular, ring, diffuse, amelanotic/vascular, tapioca and a large tumour with pupil distortion. Source: Krohn J et al., BMC Ophthalmology 2022, Fig. 2, CC BY 4.0.

Clinical photograph of iris melanoma — Classic visible pigmented iris melanoma. Jonathan Trobe, University of Michigan Kellogg Eye Center, CC BY 3.0.

For patients

A photograph cannot rule disease in or out

Choroidal and ciliary-body melanoma are usually not visible externally. Iris melanoma can also be weakly pigmented or amelanotic.

For clinicians

MRI series from one real choroidal melanoma case

The same lesion across planes and sequences.

Choroidal melanoma on contrast-enhanced T1 MRI, axial plane — T1 + contrast, axial

Choroidal melanoma on contrast-enhanced T1 MRI, coronal plane — T1 + contrast, coronal

Choroidal melanoma on T1 MRI, axial plane — T1, axial

Choroidal melanoma on T2 MRI, axial plane — T2, axial

Choroidal melanoma on FLAIR MRI, sagittal plane — FLAIR, sagittal

Author: Hellerhoff. Wikimedia Commons. CC BY-SA 4.0. Images are displayed without clinical alteration.

For clinicians: TFSOM-DIM features associated with nevus transformation

This is a risk framework, not an automatic diagnosis.

T Thickness >2 mm — USF subretinal Fluid — OCTS Symptoms: VA loss ≤20/50O Orange pigment — autofluorescenceM Melanoma acoustic hollowness — USDIM DIaMeter >5 mm — photography

Primary multimodal evidence

For clinicians: open-access multimodal clinical sets

Fundus + red-free + OCT + USCC BY 4.0 Mushroom configuration + B-scan + A-scan + UBMCC BY 4.0 Amelanotic melanoma before/after plaqueCC BY 4.0 Orange pigment + FAF + FFACC BY 4.0

For clinicians: pathology / gross specimen

Gross specimen of an enucleated eye removed for ocular melanoma — Gross specimen after enucleation for ocular melanoma. Simone Trovato Monastra, Wikimedia Commons, CC BY-SA 4.0. Intentionally kept outside the main patient flow.

Research video: UM cell transendothelial migration

Basic-science video, not patient diagnostic imaging.

Onken M, Li J, Cooper J. PLOS ONE 2014. CC BY 4.0.

Key references

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