Uveal Melanoma: Current Trends in Diagnosis and Management

Abstract

Uveal melanoma, which is the most common primary intraocular malignancy in adults, arises from melanocytes within the iris, ciliary body and choroid. The diagnosis is based principally on clinical examination of the tumor with biomicroscopy and indirect ophthalmoscopy and confirmed by diagnostic techniques such as ultrasonography, fundus fluorescein angiography and optical coherence tomography. The clinical diagnosis of posterior uveal melanomas can be made when the classical appearance of a pigmented dome-shaped mass is detected on dilated fundus exam. Uveal melanomas classically show low to medium reflectivity on A-scan ultrasonography and on B-scan ultrasonography the tumor appears as a hyperechoic, acoustically hollow intraocular mass. Management of a suspicious pigmented lesion is determined by its risk factors of transforming into a choroidal melanoma, such as documentation of growth, thickness greater than 2 mm, presence of subretinal fluid, symptoms and orange pigment, margin within 3 mm of the optic disc, and absence of halo and drusen. Advances in the diagnosis and local and systemic treatment of uveal melanoma have caused a shift from enucleation to eye-conserving treatment modalities including transpupillary thermotherapy and radiotherapy over the past few decades. Prognosis can be most accurately predicted by genetic profiling of fine needle aspiration biopsy of the tumor before the treatment, and high-risk patients can now be identified for clinical trials that may lead to target-based therapies for metastatic disease and adjuvant therapy which aims to prevent metastatic disease.

Keywords: Eye; neoplasm; uveal melanoma.

Figure 1. Color fundus photograph and spectral domain-optical coherence tomography image of choroidal melanoma in the posterior pole of the right eye before treatment

Figure 2. Color fundus photographs of choroidal melanoma before and after treatment with transpupillary thermotherapy

Figure 3. Color fundus photographs of choroidal melanoma before and after treatment with radioactive plaque brachytherapy (Iodine-125)

Figure 4. Color fundus photographs of choroidal melanoma before and after treatment with radioactive plaque brachytherapy (Ruthenium-106)

Figure 5. Color fundus photographs of choroidal melanoma before and after treatment with CyberKnife (stereotactic radiosurgery)

Figure 6. Color fundus photograph of a choroidal melanoma patient with radiation retinopathy and maculopathy