Uveal melanoma natural history, complications and prognosis: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
Poor prognostic factors for systemic disease include: | Poor prognostic factors for systemic disease include:<ref name="radio"> Uveal melanoma. Radiopedia(2015) http://radiopaedia.org/articles/primary-uveal-malignant-melanoma Accessed on October 21, 2015</ref> | ||
*Older age: >60 years of age | *Older age: >60 years of age | ||
*Larger tumors | *Larger tumors | ||
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*Cell type is the most commonly used predictor of outcome following enucleation, with spindle-A cell melanomas carrying the best prognosis and epithelioid cell melanomas carrying the least favorable prognosis. Nevertheless, most tumors have an admixture of cell types, and there is no clear consensus regarding the proportion of epithelioid cells that constitutes designation of a tumor as mixed or epithelioid. | *Cell type is the most commonly used predictor of outcome following enucleation, with spindle-A cell melanomas carrying the best prognosis and epithelioid cell melanomas carrying the least favorable prognosis. Nevertheless, most tumors have an admixture of cell types, and there is no clear consensus regarding the proportion of epithelioid cells that constitutes designation of a tumor as mixed or epithelioid. | ||
*Overall survival depends on tumour size, extraocular spread, and metastases. Even small (<10 mm diameter, <3 mm thickness) tumors still carry a 10-15% 5-year mortality. | *Overall survival depends on tumour size, extraocular spread, and metastases. Even small (<10 mm diameter, <3 mm thickness) tumors still carry a 10-15% 5-year mortality. | ||
Several additional microscopic features can affect the prognosis of intraocular melanoma, including: | *Several additional microscopic features can affect the prognosis of intraocular melanoma, including:<ref name="NIH"> Uveal melanoma. National Cancer Institute(2015) http://www.cancer.gov/types/eye/hp/intraocular-melanoma-treatment-pdq#link/_304_toc Accessed on October 23, 2015</ref> | ||
*Mitotic activity. | **Mitotic activity. | ||
*Lymphocytic infiltration. | **Lymphocytic infiltration. | ||
*Fibrovascular loops | **Fibrovascular loops | ||
*Extraocular extension, recurrence, and metastasis are associated with an extremely poor prognosis, and long-term survival cannot be expected. | **Extraocular extension, recurrence, and metastasis are associated with an extremely poor prognosis, and long-term survival cannot be expected. | ||
*The 5-year mortality rate associated with metastasis from ciliary body or choroidal melanoma is approximately 30%, compared with a rate of 2% to 3% for iris melanomas. | **The 5-year mortality rate associated with metastasis from ciliary body or choroidal melanoma is approximately 30%, compared with a rate of 2% to 3% for iris melanomas. | ||
Revision as of 14:16, 23 October 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Natural History
Complications
Complications of eye melanoma may include:
Glaucoma
Eye melanoma that is growing may cause glaucoma. Signs and symptoms of glaucoma may include the following:
- Eye pain
- Redness
- Blurry vision
Vision loss
Eye melanomas that are large often cause vision loss in the affected eye and may cause complications, such as retinal detachment, that also cause vision loss. If small eye melanomas occur in critical parts of the eye they may cause some vision loss. There may be difficulty seeing in the center of the vision or on the side. Advanced eye melanomas can cause complete vision loss.
Metastasis
Eye melanoma can spread outside of the eye and to distant areas of the body, including the liver, lungs and bones.
Prognosis
Poor prognostic factors for systemic disease include:[1]
- Older age: >60 years of age
- Larger tumors
- Anterior location within the globe
- Epithelioid cells (i.e. mixed or epithelioid histology)
- Extraocular extension
- Systemic metastases may be wide spread, with the liver > lung > bone > kidney > brain being a common sites for tumor deposits.
- Cell type is the most commonly used predictor of outcome following enucleation, with spindle-A cell melanomas carrying the best prognosis and epithelioid cell melanomas carrying the least favorable prognosis. Nevertheless, most tumors have an admixture of cell types, and there is no clear consensus regarding the proportion of epithelioid cells that constitutes designation of a tumor as mixed or epithelioid.
- Overall survival depends on tumour size, extraocular spread, and metastases. Even small (<10 mm diameter, <3 mm thickness) tumors still carry a 10-15% 5-year mortality.
- Several additional microscopic features can affect the prognosis of intraocular melanoma, including:[2]
- Mitotic activity.
- Lymphocytic infiltration.
- Fibrovascular loops
- Extraocular extension, recurrence, and metastasis are associated with an extremely poor prognosis, and long-term survival cannot be expected.
- The 5-year mortality rate associated with metastasis from ciliary body or choroidal melanoma is approximately 30%, compared with a rate of 2% to 3% for iris melanomas.
References
- ↑ Uveal melanoma. Radiopedia(2015) http://radiopaedia.org/articles/primary-uveal-malignant-melanoma Accessed on October 21, 2015
- ↑ Uveal melanoma. National Cancer Institute(2015) http://www.cancer.gov/types/eye/hp/intraocular-melanoma-treatment-pdq#link/_304_toc Accessed on October 23, 2015