[Posterior uveal pseudomelanoma. Clinical differential diagnosis at the referral hospital].

PURPOSE: To determine the rate of patients referred with diagnosis of posterior uveal melanoma to a referral hospital for such disease who were excluded for such diagnosis resting on clinical approach. To determine which are the most frequent corrected diagnosis.

METHODS: Retrospective review of clinical histories of patients referred to the Department of Ophthalmology of Hospital Universitario Clínica Puerta de Hierro from January 1983 through April 1998 with clinical diagnosis of posterior uveal melanoma.

RESULTS: Two hundred and eighty eight patients with clinical diagnosis of posterior uveal melanoma were admitted. Two hundred and eighteen of these were confirmed in their diagnosis. From the cases with corrected diagnosis, 23 correspond to small posterior uveal melanocytic tumors, 9 to posterior uveal nevi and 38 (13.2%) to lesions other than uveal melanocytic tumor. The most frequent diagnoses in the last group were spontaneous subretinal hemorrhages (11 cases) and vasoproliferative retinal tumors (6 cases). The average age of patients with subretinal hemorrhage was 72.5 +/- 8.5 years versus 55.8 +/- 14.8 years in those diagnosed of posterior uveal melanocytic tumor (PUMT) (Posterior uveal melanoma, small posterior uveal melanocytic tumor or posterior uveal nevus) (p=0.0002). Seven out of 11 (63.6%) were males versus 113 of 250 (45.2%) with PUMT. (.) Seven of 11 (63.6%) showed associated vitreous hemorrhage versus 8 of 250 (3.2%) PUMT (p<0.0001). (.) The average height was 2.34 +/- 1.57 mm in subretinal hemorraghes versus 5.37 +/- 3 mm in PUMT (p=0.03). Only 2 out of 11 showed signs of age related macular degeneration.

CONCLUSIONS: The discrepance rate (13.2% at least) between referral diagnosis and diagnosis of referral hospital for such uncommon disease as posterior uveal melanoma account for the consolidation of this referral department not only as a treatment but also as a diagnostic one. Spontaneous subretinal hemorrhages and vasoproliferative retinal tumors are the diseases that raise most of diagnostic confusions. Differential diagnosis of both of them is simple considering their clinical and epidemiologic features, in the hands of ophthalmologists expert in intraocular tumors.