Age-Related Patterns of Pseudomelanomas in Patients Referred for Suspected Uveal Melanoma at a Tertiary Ocular Oncology Center

PURPOSE: To characterize the clinical spectrum and age-distribution of pseudomelanomas in patients referred for suspected uveal melanoma at the largest ocular-oncology center in South Korea, where uveal melanoma incidence is the lowest worldwide. METHODS: A retrospective review was conducted of consecutive patients referred for suspected uveal melanoma between January 2020 and August 2025. Diagnoses were confirmed using multimodal imaging. Patients were stratified into five groups (0-20, 21-40, 41-60, 61-80, and 81-100 years) to identify age-specific diagnostic patterns. RESULTS: Of 687 patients, 564 (82.1%) had pseudomelanomas and 123 (17.9%) had clinically confirmed melanoma, 81 of which had cytologic/pathologic confirmation. Common pseudomelanomas were choroidal nevus (N=120, 21.3%), congenital hypertrophy of the retinal pigment epithelium (CHRPE, N=70, 12.4%), choroidal hemangioma (N=53, 9.4%), choroidal metastasis (N=39, 6.9%), optic disc melanocytoma (N=35, 6.2%), and retinal capillary hemangioblastoma (N=32, 5.7%). Rare entities included vortex vein varix (N=7, 1.2%), posterior nodular scleritis (N=6, 1.1%), choroidal lymphoma (N=3, 0.5%), degenerative retinoschisis (N=2, 0.4%), RPE adenoma, uveal effusion, ciliary body schwannoma, ciliary body leiomyoma (N=1, 0.2%, respectively), etc. Uveal melanoma was absent in those aged 0-20 years and predominated in adults aged 41-80 years, along with nevus and metastasis, while CHRPE, retinal capillary hemangioblastoma, and choroidal osteoma were more common in ≤40 years. Peripheral exudative hemorrhagic chorioretinopathy was predominant in ≥81 years, while primary vitreoretinal lymphoma occurred in ≥61 years. CONCLUSIONS: Pseudomelanomas accounted for over 80% of suspected uveal melanoma cases in this Korean cohort, with age-specific distribution patterns. Recognizing pseudomelanomas features and these patterns may enhance diagnostic accuracy.