Imaging Modalities for Uveal Melanoma

Abstract

Purpose: To review the spectrum of imaging modalities commonly used in clinical practice for the diagnosis and management of uveal melanoma. Materials and Methods: Review of literature. Results: Various forms of ophthalmic imaging are useful in the characterisation and treatment planning of uveal melanoma. These include digital photography, ultrasonography, angiography and optical coherence tomography. Digital photography is useful for documenting the clinical findings for future comparison and response to treatment. Ultrasonography provides information on tumour biometry, local extension and tumour composition (internal reflectivity). Angiography can be used to assess the degree of tumour vascularity. Newer forms of imaging, including optical coherence tomography (OCT), have excellent resolution and provide detail on surface features. Conclusion: The accuracy of clinical diagnosis of uveal melanoma exceeds 99 % when using currently available imaging modalities. There are advantages and disadvantages to each modality depending on tumour location, size, surface characteristics and internal structure. Ancillary techniques such as computed tomography, magnetic resonance imaging and positron emission tomography may be useful in atypical lesions or in the surveillance for metastatic disease.Uveal melanoma is the most common primary intraocular malignancy in adults and comprises approximately 85 % of all ocular melanomas. 1

Is optical coherence tomography angiography helpful in the differential diagnosis of choroidal nevus versus melanoma?

“…4,5 A number of imaging modalities are used to obtain further diagnostic information, although they all have certain limitations. 6 The emergence of optical coherence tomography (OCT) imaging has enabled in vivo identification of many histologic features of melanocytic tumors. 7 Enhanced depth imaging (EDI)-OCT of choroidal nevus shows a smoothsurface topography, chronic overlying retinal pigment epithelium (RPE), and degenerative retinal findings, mainly photoreceptor atrophy.…”

“…7 Enhanced depth imaging (EDI)-OCT of choroidal nevus shows a smoothsurface topography, chronic overlying retinal pigment epithelium (RPE), and degenerative retinal findings, mainly photoreceptor atrophy. [4][5][6][7][8][9][10][11] In comparison, EDI-OCT of choroidal melanoma generally shows a gentle, domed-shaped, smooth-surface topography, relatively fresh subretinal fluid and "bushy" photoreceptors. Bushy photoreceptors can denote edematous photoreceptors or macrophages with lipofuscin on the posterior surface of the detached retina.…”

“…4,5 A number of imaging modalities are used to obtain further diagnostic information, although they all have certain limitations. 6…”

New Perspectives in Imaging of Uveal Melanoma

“…The color of the tumor is gray to greenish brown. Retinal detachment, necrosis, or atrophy of retinal pigment epithelium cells may occur [46]. Fundus photography allows to detection of small lesions with a basal diameter lower than 3 mm [47].…”

“…Nowadays, wide-angle systems can capture up to 200°by utilizing montage images. Wide-angle systems could observe shallow margins of tumors and are precisely like USG, but these systems are characterized by low sensitivity in detecting lesions localized anterior to the equator [46,[48][49][50].…”