How do you approach the management of a patient with a small, indeterminate choroidal mass with no obvious primary malignancy?

First a careful history is obtained regarding the lesion itself. When was it first detected? Are there historical images to be obtained and reviewed? Are there symptoms associated with the lesion? When did they begin?

Then a personal medical history regarding cancer and auto-immune disease is taken.

Assuming the history is negative and the lesion is asymptomatic and history is unknown, then a complete baseline exam is established. Typically fundus photography, with auto-fluorescence is obtained,...