Choroidal tumors comprise a heterogeneous group of intraocular lesions ranging from benign entities such as choroidal nevus and circumscribed choroidal hemangioma to malignant tumors including uveal melanoma and choroidal metastasis. Accurate differentiation is crucial, as management and prognosis exhibit significant variations. Choroidal nevi are the most prevalent benign intraocular tumors and are generally asymptomatic. However, a small subset of these nevi carries a risk of malignant transformation into melanoma. Risk stratification utilizing multimodal imaging criteria, such as the TFSOM-DIM and MOLES systems, is pivotal in clinical decision-making. Uveal melanoma represents the most common primary intraocular malignancy in adults and is associated with high metastasis rates, particularly to the liver. Prognosis depends on tumor size, location, histopathologic features, and molecular alterations such as monosomy 3 or BAP1 loss. Treatment options range from globe-preserving radiotherapy to adjuvant or neoadjuvant surgical resection and enucleation in advanced cases. Choroidal hemangioma is a benign vascular tumor that can lead to visual impairment due to exudative retinal detachment. Photodynamic therapy is currently considered the preferred treatment in symptomatic cases.Choroidal metastases represent the most prevalent intraocular malignancies, with a primary origin in breast or lung carcinoma. Multimodal imaging is essential for diagnosis and monitoring, and management requires interdisciplinary coordination. A structured multimodal diagnostic approach is crucial for accurate classification, risk assessment, and individualized therapeutic planning in patients with choroidal tumors.
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