Don’t Miss the Blind Spots: Incidental Detection of Choroidal Melanoma During Primary Care Evaluation of Visual Field Loss

Identifying choroidal melanoma in the primary care setting represents a diagnostic challenge. We present a rare case of choroidal melanoma in a patient who presented with progressive superolateral quadrantanopia. A CT of the head identified an intraocular hyperdensity within the left globe. Fundoscopy confirmed a classic dome-shaped choroidal melanoma. Gene expression profiling demonstrated a class 1b uveal melanoma with PRAME positivity and mutations in GNAQ and SF3B1. Staging scans were negative for metastatic disease. Vision improved following four sessions of proton beam therapy. This case highlights the importance of multidisciplinary involvement, multimodal imaging, and gene expression profiling in facilitating early diagnosis and treatment.