*2.6.1 External examination*

An orderly approach to the exam should be taken to efficiently access and treat the patient to avoid prolonged anesthesia exposure. The overall features of the child should be assessed, evaluating for any abnormalities that are consistent with retinoblastoma and a 13Q deletion syndrome which is strongly associated with retinoblastoma risk (**Figure 2**). Patient's with 13Q deletion syndrome may have hypotelorism, micrognathia, hypoplasia of midface, absent nasal bones, large ears, hypoplastic thumbs, cleft palate, or microcephaly [17].
