Clinical management in the face of the uveal melanoma controversy.

The modalities used to diagnose choroidal melanoma are described. The use of these procedures has reduced the misdiagnosis rate from 20% in the 1960s to less than 5% today. Observation and reinvestigation of small tumours is recommended. Surgery may cause dissemination of tumour emboli, which may be prevented by gentle handling of tissue, use of intravenous mannitol and hypotensive anaesthesia. Measures other than enucleation are available to treat choroidal melanoma, but few tumours meet the criteria for their use.