Management of Uveal Melanoma: A Consensus-Based Provincial Clinical Practice Guideline

Weis, Ezekiel; Salopek, Thomas G.; McKinnon, J. Gregory; Larocque, M.; Temple‐Oberle, Claire; Cheng, Tina; McWhae, John A.; Sloboda, Ron S.; Shea‐Budgell, Melissa

doi:10.3747/co.23.2859

Cited by 59 publications

(73 citation statements)

References 97 publications

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“…2 Risk factors included in this analysis: tumor thickness >2 mm (T), distance to optic disc margin <3 mm (M), presence of orange pigment (O), presence of subretinal fluid (F), symptoms (S), absence of drusen, acoustic hollowness on ultrasound, and presence of halo. 3 Risk factors include TFSOM.…”

Section: Resultsmentioning

confidence: 99%

“…Waiting for growth to occur in small lesions identified as high risk by an ophthalmologist can increase the risk of metastasis even when controlling for tumor size (relative risk of 8 controlling for tumor size) [4,5]. Therefore, high-risk melanocytic lesions ≤3 mm in thickness without any documentation of growth may be offered treatment [3,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Advances over the past few decades have given us powerful tools for controlling uveal melanoma locally and preventing enucleation; however, we have yet to develop an effective treatment to reduce the risk of metastatic disease or to effectively treat it when it occurs [1][2][3]. Waiting for growth to occur in small lesions identified as high risk by an ophthalmologist can increase the risk of metastasis even when controlling for tumor size (relative risk of 8 controlling for tumor size) [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Gene Expression Profiling as an Adjunctive Measure to Guide the Management of Indeterminate, High-Risk Choroidal Melanocytic Lesions: A Pilot Study

et al. 2018

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Purpose: To describe our early experience with gene expression profiling (GEP) assessment for juxtafoveal, subfoveal, and peripapillary indeterminate high-risk melanocytic lesions to assist in making early treatment decisions in patients who did not feel comfortable with either close observation or definitive treatment. Methods: A prospective cohort of patients with indeterminate lesions who underwent GEP were enrolled. Nonparametric statistical analysis was utilized given the small sample size. Results: Fifteen patients were included in this series. Six (40%) were class 1A and 9 (60%) class 1B. Class 1A and 1B lesions had a median of three and four clinical risk factors, respectively (p = 0.27). There was no statistically significant difference for the largest basal diameter between the classes (p = 0.31); however, class 1B lesions were thicker than class 1A lesions (p = 0.03). None of the class 1A lesions showed definite growth or metastasis over a mean follow-up period of 17.1 ± 1.8 months from fine needle aspiration biopsy. All class 1B patients opted for plaque brachytherapy, and to date none of these patients have developed metastasis, with a mean follow-up of 18.7 ± 8.4 months. Conclusion: There may be a role for GEP assessment in high-risk, indeterminate, posteriorly located choroidal lesions to assist in treatment planning.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gene Expression Profiling as an Adjunctive Measure to Guide the Management of Indeterminate, High-Risk Choroidal Melanocytic Lesions: A Pilot Study

et al. 2018

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“…However, in a large series of patients followed at a tertiary care center, nevus growth into melanoma occurred in 2, 9, and 13% of eyes at 1, 5, and 10 years, respectively [17]. Despite many advances in our ability to locally treat uveal melanoma, we have yet to develop an effective treatment to reduce the risk of metastasis, or effectively treat it when it occurs [18-20]. It has been well established that larger tumor size is associated with a greater risk of metastasis and melanoma-specific mortality [21-26].…”

Section: Discussionmentioning

confidence: 99%

Tele-Oncology: A Validation Study of Choroidal and Iris Nevi

Roelofs

Weis

2018

Ocul Oncol Pathol

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Background/Aims: To evaluate teleophthalmological assessment of choroidal and iris nevi (tele-oncology) compared to traditional in-person clinical evaluation for detection of either axial or basal growth. Methods: This is a validation study. All 97 eyes of 99 patients were evaluated with an in-person ocular oncology visit utilizing standard testing, and subsequently had a tele-oncology evaluation with the standardized tests. The tele-oncology reviewer was blinded to the in-person examination findings. The primary study outcome was detection of nevus growth on tele-oncology compared to in-person clinical examination. Results: Patients had a mean age of 61 years and the majority had nevi located in the choroid (n = 87; 88%). The most common diagnosis was a low-risk nevus (n = 38; 44%). By tele-oncology assessment, 11 eyes showed growth. Ten of these patients had growth confirmed on in-person clinical examination. Resultantly, tele-oncology assessment of choroidal and iris nevi growth had a sensitivity of 100%, specificity of 99%, positive predictive value (PPV) of 91%, and negative predictive value (NPV) of 100%. Conclusions: The results of this study suggest that tele-oncology is a safe platform for monitoring choroidal and iris nevi for growth, with excellent sensitivity, specificity, PPV, and NPV.

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“…Despite being the most common primary intraocular malignancy in adults, uveal melanoma only accounts for 5% of all melanomas 4. Although it can arise anywhere within the uveal tract, uveal melanoma occurs far more frequently in the choroid (90%) than in the ciliary body (6%) and the iris (4%) 5.…”

Section: Introductionmentioning

confidence: 99%

Orbital recurrence of iris melanoma 21 years after enucleation

et al. 2017

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We present the case of a 56-year-old man who developed a neoplasm of epithelioid histology in his anophthalmic left orbit 21 years after he underwent enucleation for a spindle cell iris melanoma. The recurrent tumour was managed by orbital exenteration. Neither further recurrence nor metastasis was diagnosed over a 5-year follow-up period. This case, along with five other similar cases in the literature, emphasises the importance of long-term follow-up after treatment of iris melanoma.

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Management of Uveal Melanoma: A Consensus-Based Provincial Clinical Practice Guideline

Abstract: Introduction Survival in uveal melanoma has remained unchanged since the early 1970s. Because outcomes are

Cited by 59 publications

References 97 publications

Gene Expression Profiling as an Adjunctive Measure to Guide the Management of Indeterminate, High-Risk Choroidal Melanocytic Lesions: A Pilot Study

Gene Expression Profiling as an Adjunctive Measure to Guide the Management of Indeterminate, High-Risk Choroidal Melanocytic Lesions: A Pilot Study

Tele-Oncology: A Validation Study of Choroidal and Iris Nevi

Orbital recurrence of iris melanoma 21 years after enucleation

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