Incidentally Detected Large Choroidal Melanoma in a 27-Year-Old Asymptomatic Woman: A Case Report

Choroidal melanoma is the most common primary intraocular malignancy. Although rare, early diagnosis is crucial given its significant impact on both visual and vital prognoses. It often develops insidiously and is discovered incidentally. We report the case of a 27-year-old asymptomatic woman in whom a choroidal melanoma was incidentally discovered during a routine ophthalmologic examination. Fundus evaluation revealed a large inferotemporal pigmented choroidal mass in the left eye. Multimodal imaging, that is, B-scan ultrasonography, optical coherence tomography, fluorescein and indocyanine green angiography, and orbital magnetic resonance imaging (MRI), documented a characteristic mushroom-shaped lesion measuring 9.42 mm in largest basal diameter and 10.74 mm in apical thickness, with low-to-medium internal reflectivity, associated exudative retinal detachment, and a T1-hyperintense/T2-hypointense signal pattern. A contrast-enhanced whole-body computed tomography (CT) scan was performed, revealing two solid pulmonary parenchymal nodules in the right lower lobe, measuring 5 mm and 4 mm. Given the tumor dimensions, location, and extension, globe-conserving brachytherapy was not feasible, and urgent enucleation was performed. Management of choroidal melanoma ranges from globe-conserving radiotherapy to enucleation, with prognosis closely tied to tumor size at diagnosis and to the risk of hematogenous metastasis. The educational message of this case is twofold: choroidal melanoma may occur in young, asymptomatic patients and remain clinically silent until an advanced stage, and systematic dilated fundus examination, even in low-risk populations undergoing routine refraction, remains the single most effective means of detecting a potentially lethal intraocular malignancy at a treatable stage.