Understanding Skin Cancer -- the Basics
From symptoms to prevention, get the basics on skin cancer from the experts at WebMD.
10 Questions to Ask Your Doctor About Melanoma
If you've just been diagnosed with melanoma, you have questions. WebMD experts provide 10 questions you might want to ask your doctor.
Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Medium and Large Choroidal Melanoma
Eye-sparing radiation therapy, either by plaque brachytherapy or external beam, is the preferred option for most patients with medium-sized choroidal melanoma. Enucleation remains the standard therapy for large, choroidal melanomas and melanomas that cause severe glaucoma or invade the optic nerve. Standard treatment options:Tumor growth pattern is a factor in the therapeutic decision. If there is a diffuse melanoma or if there is extraocular extension, enucleation should be considered, but radiation therapy can be employed for less extensive disease. Medium-sized choroidal melanomasPlaque radiation therapy.[1,2,3,4]External-beam, charged-particle radiation therapy: This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.[5,6,7]Local eye-wall resection.[8,9]Combined therapy, with ablative laser coagulation or transpupillary thermotherapy to supplement plaque treatment.[10,11]Enucleation. This approach is
Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Iris Melanoma
Melanocytic stromal proliferations and nevi of the iris are the most common tumors of the iris, but melanoma is rare.[1,2] Clinical differentiation between an iris nevus and a melanoma might sometimes be difficult and at times may be impossible. Melanomas of the iris are usually small discrete lesions, though they may occasionally be diffuse, infiltrative, or multiple, and they may result in heterochromia, chronic uveitis, or spontaneous hemorrhage into the anterior chamber of the eye (hyphema). Iris melanomas that involve more than 66% of the angle circumference are associated with secondary glaucoma.Routine evaluation of iris melanomas includes gonioscopy, transillumination of the globe, and indirect ophthalmoscopy with 360° of scleral depression. Photographic documentation is essential to document progression in size or growth of the tumor. Anterior segment fluorescein angiography may be helpful to demonstrate the vascularity of the lesion but is not diagnostic.
Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Extraocular Extension and Metastatic Intraocular Melanoma
Extrascleral extension confers a poor prognosis. For patients with gross tumor involvement of the orbit, treatment requires orbital exenteration. However, there is no evidence that such radical surgery will prolong life. Most patients with localized or encapsulated extraocular extension are not exenterated. This subject is controversial.[1,2,3,4,5]No effective method of systemic treatment has been identified for patients with metastatic ocular melanoma. Available clinical trials should be considered as an option for these patients.Current Clinical TrialsCheck for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with extraocular extension melanoma and metastatic intraocular melanoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.General information about clinical trials is also available from the NCI Web site.References: Shammas HF, Blodi FC: Prognostic factors in choroidal and
Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Ciliary Body Melanoma
Melanoma involving the ciliary body is a rare tumor that carries a poor prognosis. In some cases, diagnosis may be difficult because of similarity to other eye diseases. The differential diagnosis of ciliary body melanoma should be considered in cases of unilateral pigmentary glaucoma and chronic uveitis.Ultrasound biomicroscopy can be used to evaluate tumor shape, thickness, margins, reflectivity, and local invasion.[2,3] Patients with tumors greater than 7 mm in thickness are at increased risk for metastatic disease and melanoma-related death compared with patients with thinner tumors.Standard treatment options:There are several options for management of ciliary body melanoma. All of them are reported from case series.[Level of evidence: 3iiiDiv] The choice of therapy, however, depends on many factors.Plaque radiation therapy: Local control rates are high, but treatment is associated with a high incidence of secondary cataract.[4,5]External-beam, charged-particle radiation
Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - About This PDQ Summary
Purpose of This SummaryThis PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of intraocular melanoma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.Reviewers and UpdatesThis summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH). Board members review recently published articles each month to determine whether an article should:be discussed at a meeting,be cited with text, orreplace or update an existing article that is already cited.Changes to the summaries are made through a consensus process
Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Classification and Stage Information for Intraocular (Uveal) Melanoma
Tumor SizeUveal melanoma most often assumes a nodular or dome-shaped configuration, but occasionally tumors can be flat or diffuse and involve extensive areas of the uvea with little elevation. Tumor size classifications according to boundary lines used in a Collaborative Ocular Melanoma Study (COMS) are as follows: Small: Range from 1.0 mm to 3.0 mm in apical height and largest basal diameter of 5.0 to 16.0 mm. Medium: Range from 3.1 to 8.0 mm in apical height and a basal diameter of not more than 16.0 mm. Large: Greater than 8.0 mm in apical height or a basal diameter more than 16.0 mm, when the apical height is at least 2.0 mm.Although most ocular melanomas have a raised configuration, about 5% grow in a diffuse pattern that also may have prognostic significance. The tumors have a horizontal, flat-growth pattern, with the thickness measuring approximately 20% or less than the greatest basal dimension. This uncommon variant of uveal
Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Recurrent Intraocular Melanoma
The prognosis for any patient with recurring or relapsing disease is poor, regardless of cell type or stage. The question and selection of further treatment depends on many factors, including the extent of the lesion, age and health of the patient, prior treatment, and site of recurrence, as well as individual patient considerations. Surgical resection of metastases diagnosed subsequent to initial management of ocular melanoma in single-center, case series of highly selected patients has been reported. The extent to which the occasional favorable outcomes are the result of strong selection factors is not clear, so this approach cannot be considered standard.Clinical trials are appropriate, and eligible patients should be advised to consider participation in them whenever possible. Current Clinical TrialsCheck for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent intraocular melanoma. The list of clinical trials can be
Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Cellular Classification of Intraocular (Uveal) Melanoma
Primary intraocular melanomas originate from melanocytes in the uveal tract. Four distinct cellular types are recognized in intraocular melanoma (revised Callender classification):Spindle-A cells (spindle-shaped cells with slender nuclei and lacking visible nucleoli). Spindle-B cells (spindle-shaped cells with larger nuclei and distinct nucleoli).Epithelioid cells (larger polygonal cells with one or more prominent nucleoli).Intermediate cells (similar to but smaller than epithelioid cells).Most primary intraocular melanomas contain variable proportions of epithelioid, spindle-A, and spindle-B cells (mixed-cell melanomas). Pure epithelioid-cell primary melanomas are infrequent (approximately 3% of cases). In the Collaborative Ocular Melanoma Study, mixed-cell type melanomas predominated (86% of cases).References: Klintworth GK, Scroggs MW: The eye and ocular adnexa. In: Sternberg SS, ed.: Diagnostic Surgical Pathology. Philadelphia, Pa: Lippincott Williams & Wilkins, 1999,