The surgical approach to the management of anterior uveal melanomas

Rospond-Kubiak, Iwona; Damato, Bertil

doi:10.1038/eye.2014.74

Cited by 18 publications

(12 citation statements)

References 15 publications

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“…A small lesion with a basal diameter <3 mm, with no other sign and no symptoms, that may be a nevus or a small melanoma (indeterminate lesions), can be monitored periodically with photographic documentation for evaluating possible growth ( 10 ). Small circumscribed lesions with documented growth can be treated with sector iridectomy ( 93 ). If there is an involvement of the anterior chamber, a portion of the trabecular meshwork needs to be removed as well; this type of resection is termed iridotrabeculectomy.…”

Section: Primary Tumor Treatmentmentioning

confidence: 99%

“…If there is an involvement of the ciliary body, an iridocyclectomy can be performed, resecting a portion of the iris and ciliary body ( 10 ). Intraocular surgery can be associated with complications, such as hypotony, retinal detachment, lens subluxation, phthisis, endophthalmitis and sympathetic ophthalmia ( 93 - 95 ). Larger melanomas are usually non-resectable and treatment is based on radiotherapy or enucleation ( 10 , 96 - 98 ).…”

Section: Primary Tumor Treatmentmentioning

confidence: 99%

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Current molecular and clinical insights into uveal melanoma (Review)

et al. 2021

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Uveal melanoma (UM) represents the most prominent primary eye cancer in adults. With an incidence of approximately 5 cases per million individuals annually in the United States, UM could be considered a relatively rare cancer. The 90-95% of UM cases arise from the choroid. Diagnosis is based mainly on a clinical examination and ancillary tests, with ocular ultrasonography being of greatest value. Differential diagnosis can prove challenging in the case of indeterminate choroidal lesions and, sometimes, monitoring for documented growth may be the proper approach. Fine needle aspiration biopsy tends to be performed with a prognostic purpose, often in combination with radiotherapy. Gene expression profiling has allowed for the grading of UMs into two classes, which feature different metastatic risks. Patients with UM require a specialized multidisciplinary management. Primary tumor treatment can be either enucleation or globe preserving. Usually, enucleation is reserved for larger tumors, while radiotherapy is preferred for small/medium melanomas. The prognosis is unfavorable due to the high mortality rate and high tendency to metastasize. Following the development of metastatic disease, the mortality rate increases to 80% within one year, due to both the absence of an effective treatment and the aggressiveness of the condition. Novel molecular studies have allowed for a better understanding of the genetic and epigenetic mechanisms involved in UM biological activity, which differs compared to skin melanomas. The most commonly mutated genes are GNAQ, GNA11 and BAP1. Research in this field could help to identify effective diagnostic and prognostic biomarkers, as well as novel therapeutic targets.

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Section: Primary Tumor Treatmentmentioning

confidence: 99%

Section: Primary Tumor Treatmentmentioning

confidence: 99%

Current molecular and clinical insights into uveal melanoma (Review)

et al. 2021

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“…Die Bestrahlung mittels radioaktiver Applikatoren (für umschriebene noduläre Tumoren) und insbesondere die Protonenbestrahlung (unabhängig vom Wachstumsmuster) sind sehr gut geeignet, um Irismelanome zu behandeln. Bei umschriebenen nodulären Tumoren kann jedoch eine chirurgische Resektion durchgeführt werden, obwohl dadurch ein meist großes, funktionell beeinträchtigendes und schwer zu rekonstruierendes chirurgisches Kolobom resultiert [14,17,18,[69][70][71]. Bei der Trepanationstechnik erfolgt eine Blockexzision aus Anteilen der Hornhaut, der Iris, des Kammerwinkels, der Sklera und des Ziliarkörpers mithilfe eines Trepans.…”

Section: Iridotrabekulozyklektomieunclassified

Chirurgische Methoden in der Behandlung des Aderhautmelanoms

Blatsios

Haas

Zehetner

et al. 2017

Klin Monatsbl Augenheilkd

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Significant advancements have been made in the last decades in the treatment of uveal melanoma. Radiation therapy can achieve, depending on the method, local tumour control in up to 98% of cases. Surgical modalities have been implemented in the ocular therapy for uveal melanoma either to treat/prevent radiation complications, such as so-called toxic tumour syndrome, or to primarily treat the tumour with or without adjunctive radiotherapy. These include endoresection and transscleral resection for melanomas of the choroid/ciliary body or irido-trabeculo-cyclectomy for melanomas of the iris-ciliary body. Furthermore, tumour biopsy is playing a progressively more important role in the diagnosis, treatment and follow-up planning of melanoma cases. This paper focuses on the background, the surgical technique as well as the results and complications of tumour excisional and biopsy surgery.

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“…[2][3][4] Iris melanoma treatments include local surgical excision, radiation therapy, and enucleation. [1][2][3][4][5][6][7][8][9][10][11] While the primary goal is removal or destruction of the tumor, the evolving trends have been toward eye and vision preservation. Treatment depends on tumor size and location.…”

Section: Introductionmentioning

confidence: 99%

Palladium-103 plaque therapy for multifocal iris melanoma: Radiation of the entire anterior segment of the eye

Finger

Tomar

Chin

2020

European Journal of Ophthalmology

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Purpose: To investigate the safety and tolerability of total anterior segment palladium-103 (103Pd) eye plaque brachytherapy for multifocal iris melanoma. Methods: Interventional case series of 11 patients with multifocal iris melanomas. Anterior segment ultrasound revealed tumor size, location, and intraocular margins. Epicorneal amniotic membrane grafts protected the cornea and decreased pain during total anterior segment 103-Pd ophthalmic plaque brachytherapy. Results: Eleven diffuse iris melanomas were American Joint Committee on Cancer 8th edition–classified as T1 (n = 5, 45.5%) and T2 (n = 6, 54.5%). Plaque radiation was completed to a minimum mean tumor dose of 85 Gy (mean dose rate, 58.1 cGy/h). Ultrasonographic tumor thickness regression was 41% (follow up mean 58.7, median 50, range: 8–139 months). Despite 100% local control and 100% eye retention, one patient (9.1%) developed metastatic disease. Four eyes required cataract surgery. There was no corneal stem-cell deficiency, corneal opacity, radiation maculopathy, or optic neuropathy. While visual acuity prior to treatment was 20/40 or better in 10 (91%), 9 were 20/40 or better (81.9%) at last follow-up. Four (36%) had glaucoma prior to treatment and three eyes developed glaucoma after treatment for a total of 63%. Conclusion: Total anterior segment (103Pd) plaque brachytherapy resulted in local control, good visual acuity, eye and life preservation in the treatment of multifocal iris melanoma.

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The surgical approach to the management of anterior uveal melanomas

Cited by 18 publications

References 15 publications

Current molecular and clinical insights into uveal melanoma (Review)

Current molecular and clinical insights into uveal melanoma (Review)

Chirurgische Methoden in der Behandlung des Aderhautmelanoms

Palladium-103 plaque therapy for multifocal iris melanoma: Radiation of the entire anterior segment of the eye

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