Uveal melanoma medical therapy

Uveal melanoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Uveal melanoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Echocardiography and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Uveal melanoma medical therapy On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Uveal melanoma medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Uveal melanoma medical therapy
CDC on Uveal melanoma medical therapy
Uveal melanoma medical therapy in the news
Blogs on Uveal melanoma medical therapy
to Hospitals Treating Uveal melanoma
Risk calculators and risk factors for Uveal melanoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Medical Therapy

Standard treatment options for iris melanoma include the following:

• Observation with careful follow-up

In asymptomatic patients with stable lesions; follow-up includes serial photography.

• Local resection

When progressive and pronounced growth is documented.[2]

• Enucleation

If the tumor is not amenable to local resection (diffuse involvement of the iris, involvement of more than 50% of the iris and anterior chamber angle, intractable glaucoma, and extraocular extension).

• Plaque radiation therapy

Offered as an alternative for large, diffuse, surgically nonresectable lesions of the iris

There are several options for management of ciliary body melanoma. The choice of therapy, however, depends on many factors. Standard treatment options for ciliary body melanoma include:

• Plaque radiation therapy

Local control rates are high, but treatment is associated with a high incidence of secondary cataract.

• External-beam, charged-particle radiation therapy

This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.

• Local tumor resection

This option is mainly suitable for selected ciliary body or anterior choroidal tumors with smaller basal dimension and greater thickness.

• Enucleation This option is generally reserved for large melanomas when there is no hope of regaining useful vision. It is also indicated in the presence of intractable secondary glaucoma and extraocular extension.

Standard treatment options for small choroidal melanoma include:

• Observation

This strategy is important for patients with an uncertain diagnosis or in whom tumor growth has not been documented. It is also used for asymptomatic patients with stable lesions (particularly elderly or debilitated patients), and patients with a tumor in their only useful eye.

• Plaque radiation therapy

This treatment is used for small- or medium-sized uveal melanomas, amelanotic tumors, or tumors that touch the optic disc for greater than 3 clock-hours of optic disk circumference.

• External-beam, charged-particle radiation therapy

This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.

• Gamma-knife radiation surgery

This treatment may be a feasible option for small-sized to medium-sized melanomas.

• Transpupillary thermotherapy

As noted above, this approach has very limited use, but it can be used as a primary treatment or as an adjunctive method to plaque radiation therapy.

• Local tumor resection

This strategy is used mainly for selected ciliary body or anterior choroidal tumors with smaller basal dimensions and greater thickness.

• Enucleation

This approach is used when severe intraocular pressure elevation is a factor. It may also be considered with small- and medium-sized melanomas that are invading the tissues of the optic nerve.

Standard treatment options for medium-sized choroidal melanomas include:

• Plaque radiation therapy.
• External-beam, charged-particle radiation therapy: This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.
• Local eye-wall resection.
• Combined therapy, with ablative laser coagulation or transpupillary thermotherapy to supplement plaque treatment.
• Enucleation. This approach is considered primarily for diffuse melanomas or for cases in which there is extraocular extension; radiation complications or tumor recurrence may sometimes make enucleation necessary.

Standard treatment option for large choroidal melanomas include: Enucleation when the tumor is judged to be too large for eye-sparing approaches.