British Journal of Ophthalmology, 1983, 67, 236-243 Resection of uveal melanocytoma: clinicopathological correlation MOTILAL RAICHAND, GHOLAM A. PEYMAN, CLAUDIO P. JUAREZ, AVRON A. SEETNER, JOEL SUGAR. AND MORTON F. GOLDBERG From the Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago, USA SUMMARY Four patients had pigmented lesions in the anterior uveal tract and choroid which presented clinically as malignant melanomas. All the lesions were successfully removed by local excision. Histopathological studies showed the tumours to be melanocytomas, indicating that enucleation or irradiation would have been contraindicated. The 3 patients with iris and ciliary body melanocytomas continue to maintain corrected visual acuities of 20/30 or better. In the patient with choroidal melanocytoma central visual acuity was compromised owing to cystoid macular oedema. All 3 melanocytomas involving the anterior segment were located inferiorly. Biomicro- scopically, they were chocolate coloured (not black) and resembled malignant melanomas of the same location. The choroidal melanocytoma also resembled a malignant melanoma by ophthal- moscopic and angiographic criteria, and did not have the jet black or homogeneous pigmentation that characterises most melanocytomas of the disc. Melanocytoma was first described as a distinct clinicopathological entity by Zimmerman and Garron' in 1962. They identified it as a type of benign naevus involving the optic nerve head. Character- istically it is a slow-growing maximally pigmented tumour that occurs preponderantly in noncaucasians or deeply pigmented individuals. Although the tumour may give the clinical and histopathological impression of infiltrating the ocular structures,2" no evidence of metastasis has ever been reported. Melanocytoma is classically located at the optic disc,2 although rarely it has been described in the choroid,' ciliary body,6 and iris.7 Differentiation from other pigmented tumours is often possible at the optic disc because of the rarity of other pigmented lesions in this location.2 However, differentiation from malignant melanomas occupying the choroid, ciliary body, or iris is extremely difficult on clinical grounds alone. Unfortunately the final diagnosis is usually made on histopathological examination. Any clinical observation that distinguishes these tumours is of obvious importance and could prevent unnecessary enucleation or irradiation. We here report 4 cases of histologically confirmed Correspondence to Dr G. A. Peyman, University of Illinois Hospital Eye and Ear Infirmary, 1855 W Taylor St, Chicago, IL 60612, USA. melanocytoma of the iris, ciliary body, and choroid which clinically appeared to be malignant melanomas. These tumours were successfully resected with main- tenance of good visual acuity in the operated eyes. Most of the operations were performed by one of us (G.A.P.). Fig. I Case l. Gionlophotograph of inferior aspect of left eye. Pigmented lesion extends between 6 and 8 o'clock (arrows). 236