Extrascleral Extension from Choroidal Melanoma Diagnosed on Doppler Ultrasound

A 50-year-old woman was referred to our service with an amelanotic choroidal tumor in the right eye that we believed was a melanoma (Fig A). B-scan ultrasound suggested extraocular spread in the region of the inferior oblique muscle (Fig B). A Doppler scan showed that the tumor had blood flow (9.2 cm/s), distinguishing it from muscle (Fig C). Histology of the enucleated globe confirmed the diagnosis of choroidal melanoma with extrascleral extension (Fig D) (Magnified version of Fig A-D is available online at www.aaojournal.org).