Presumed small choroidal melanomas with serous macular detachments with and without surface laser photocoagulation treatment.

We reviewed the records of 22 patients (22 eyes) who had presumed small choroidal melanomas associated with a serous macular detachment. In 13 eyes, the tumor surface was treated with laser photocoagulation to reattach the retina and improve vision. After photocoagulation, the retina reattached in 11 eyes (85%), and the visual acuity improved in eight eyes (62%), returning to 20/25 or better in six eyes (46%). Twelve of the tumors (92%) that received surface photocoagulation grew after treatment. Seven of these tumors (54%) developed a collar-button configuration and showed evidence of basal expansion. Of the nine tumors that did not receive surface photocoagulation, seven (78%) eventually grew, but none developed a collar-button configuration. Surface photocoagulation applied to a growing melanoma appears to increase the likelihood of tumor extension through Bruch's membrane in a collar-button configuration. The impact of such growth on tumor metastasis is unknown.