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In the past, enucleation (eye removal) was the accepted standard treatment for primary choroidal melanoma, and it remains the most commonly used treatment for large tumors. Because of the effect of enucleation on the appearance of the patient, the diagnostic uncertainty encountered by the ophthalmologist (particularly in the case of smaller tumors), and the potential for tumor spread, alternative treatments, such as radiation therapy (i.e., brachytherapy or external-beam, charged-particle radiation therapy), transpupillary thermotherapy, photocoagulation, and cryotherapy have been developed in an attempt to spare the affected eye and possibly retain useful vision.[10,11] One of the clinical trials of the randomized Collaborative Ocular Melanoma Study compared iodine 125 (125 I) episcleral-plaque brachytherapy to enucleation in treating patients with medium-sized choroidal tumors.[12] Eighty-five percent of the patients treated with 125 I brachytherapy retained their eye for 5 years or more, and 37% had visual acuity better than 20/200 in the irradiated eye 5 years after treatment.[12] No significant differences in mortality were observed between the two study arms after 12 years of follow-up, whether considering death from all causes or death with histopathologically confirmed melanoma metastasis.[13]

References:

  1. Singh AD, Bergman L, Seregard S: Uveal melanoma: epidemiologic aspects. Ophthalmol Clin North Am 18 (1): 75-84, viii, 2005.
  2. Weis E, Shah CP, Lajous M, et al.: The association between host susceptibility factors and uveal melanoma: a meta-analysis. Arch Ophthalmol 124 (1): 54-60, 2006.
  3. Yap-Veloso MI, Simmons RB, Simmons RJ: Iris melanomas: diagnosis and management. Int Ophthalmol Clin 37 (4): 87-100, 1997 Fall.
  4. Eye and ocular adnexa. In: Rosai J: Ackerman's Surgical Pathology. 8th ed. St. Louis, Mo: Mosby, 1996, pp 2449-2508.
  5. Avery RB, Mehta MP, Auchter RM, et al.: Intraocular melanoma. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1800-24.
  6. McLean IW: Prognostic features of uveal melanoma. Ophthalmol Clin North Am 8 (1): 143-53, 1995.
  7. Gragoudas ES, Egan KM, Seddon JM, et al.: Survival of patients with metastases from uveal melanoma. Ophthalmology 98 (3): 383-9; discussion 390, 1991.
  8. Introduction to melanocytic tumors of the uvea. In: Shields JA, Shields CL: Intraocular Tumors: A Text and Atlas. Philadelphia, Pa: Saunders, 1992, pp 45-59.
  9. White VA, Chambers JD, Courtright PD, et al.: Correlation of cytogenetic abnormalities with the outcome of patients with uveal melanoma. Cancer 83 (2): 354-9, 1998.
  10. Zimmerman LE, McLean IW, Foster WD: Statistical analysis of follow-up data concerning uveal melanomas, and the influence of enucleation. Ophthalmology 87 (6): 557-64, 1980.
  11. De Potter P, Shields CL, Shields JA: New treatment modalities for uveal melanoma. Curr Opin Ophthalmol 7 (3): 27-32, 1996.
  12. Diener-West M, Earle JD, Fine SL, et al.: The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: initial mortality findings. COMS Report No. 18. Arch Ophthalmol 119 (7): 969-82, 2001.
  13. Collaborative Ocular Melanoma Study Group.: The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol 124 (12): 1684-93, 2006.
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Last Updated: October 07, 2011
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