Can a very large choroidal tumor truly be low risk if shown so in monosomy 3 test result (I thought 'large' usually meant high risk)?

Dx: Very large tumor, enucleated, some extra scleral extensions, not in ciliary body, originates in choroid, brown and black pigmentation.
Test: Monosomy 3 (MLPA method) test shows no loss of chromosome 3 nor extra chromosome 8.

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WilliamHarbourMD (Physician - Ophthalmology (Eyes) (Verified) ) - 10 / 05 / 2012

I do not trust the monosomy 3 test, so I cannot specifically comment on that aspect of the question. The monosomy 3 test is inferior to the Castle Biosciences test that gives a class 1 or class 2 result. All but 2-3 centers in the US are now using it. However, I can say that I have had many patients with a very large choroidal/uveal melanoma that was class 1 (low metastatic risk). I can remember one patient in particular whose tumor filled the entire eye. The tumor was class 1, and she is still alive and healthy and the mother of a healthy young child 16 years later. So, larger tumors tend to be the high risk tumors but not always. That is why prognostic testing is important.

I would not take much comfort in the monosomy 3 test result. If the patient's eye was removed, the Castle test can still be performed since the eye should be kept in the pathology laboratory of the hospital where she had the surgery. If patients are interested they can contact Castle Biosciences at 866-788-9007 or visit their website at

* Disclosure: J. William Harbour may receive income based on a license of technology to Castle Biosciences, Inc.

EvangelosGragoudasMD (Physician - Ophthalmology (Eyes) (Verified) ) - 10 / 16 / 2012

Yes, a large melanoma could be low risk if shown not to have monosomy 3. However, most large melanomas have monosomy 3.
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