Noncontiguous Tumor Recurrence of Posterior Uveal Melanoma After Transscleral Local Resection

Abstract

To describe the clinical and histopathologic features of noncontiguous tumor recurrence after transscleral local resection of posterior uveal melanoma. Methods: Chart review was performed to identify patients with noncontiguous tumor recurrences from a series of 494 consecutive patients treated with transscleral local resection for uveal melanoma. The clinical and histopathologic features of noncontiguous tumor recurrences were studied. Results: Nine cases were identified, for an estimated incidence of 1.8%. The average diameter of the primary tumors was 16.1 mm (range, 9-22 mm) and the average thickness was 9.8 mm (range, 6-14 mm). Noncontiguous tumor recurrences were solitary in 7 cases and multiple in 2 cases, with an average diameter of 5.8 mm (range, 3.0-9.5 mm). Eight of the 9 patients developed tumor recurrences at multiple intraocular sites. With a mean follow-up of 82.1 months (range, 22-171 months), 7 patients had a final visual acuity of counting fingers or worse, and there were 3 deaths from metastatic disease. Conclusions: Noncontiguous tumor recurrence after local resection appears to be related to intraocular dissemination from the primary tumor, either through the natural course of the disease or secondary to surgical manipulation. Eyes with large primary uveal melanomas developing noncontiguous tumor recurrence have a high risk of developing tumor spread to multiple intraocular sites, and aggressive treatment is warranted.

Recurrent choroidal melanoma after transscleral local resection with diffuse vitreous seeding

“…Non-contiguous intraocular tumour recurrences have also been described following local resection of primary posterior uveal melanomas [5]. The possible mechanisms for this include multifocal melanomas, uveal dissemination of the primary tumour, seeding secondary to surgical manipulation, and tumour spread from residual melanoma after local resection.…”

Clinicopathologic correlations in eyes enucleated after uveal melanoma resection with positive surgical margins

“…Noncontiguous tumor recurrence of uveal melanoma after local resection has been reported 8,10 . Evaluation of the surgical margins of resection is, at best, a percentage of the margin of the entire specimen.…”

Intraocular leiomyoma: Current concepts

“…23,36,62 Partial lamellar sclerouvectomy has also been associated with local tumor dissemination. 51 These risks must be considered in light of the results from a multicenter international uveal melanoma registry analysis which found failure of local control to carries a 6.3 Â hazard ratio for metastatic uveal melanoma death. 67 Because of the inability to distinguish clinically uveal leiomyoma from melanoma, the surgical excision planning for the both these lesions may include a wide excision margin and for melanoma, adjunctive plaque brachytherapy.…”