Uveal melanoma medical therapy
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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
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.