Choroidal melanoma is one of the most malignant tumors of the organ of vision, the development of which is associated with the risk of metastasis and the possibility of death, which indicates the relevance of the search and application of effective methods of treatment of this pathology. To date, in the treatment of choroidal melanoma, preference is given to organ-preserving methods aimed at achieving local control over the tumor. One of the promising organ-preserving techniques is photodynamic therapy, which is a treatment method based on the ability of a photosensitizer to absorb light, receive energy and interact with chemical substances, with the further development of toxic photodynamic reactions in target tissues, the occurrence of which is possible with the simultaneous presence of three components: a photosensitizer, light and oxygen. In our country, there is a number of studies devoted to the treatment of choroidal melanoma with PDT, basically presenting experimental research, pilot studies and demonstrating clinical cases. The purpose of this review is to summarize data on photodynamic therapy and the use of this technique in the treatment of choroidal melanoma.
The purpose was to study the prevalence of metastasis of choroidal melanoma (CM) and clinical and instrumental criteria of the risk of such metastasis.Material and methods. A detailed analysis of clinical material for the period of 2000–2018 is presented, involving 304 patients with CM under continuous observation by an ophthalmic oncology center of a multidisciplinary cancer institution. Results. Metastatic lesion of various organs was diagnosed in 66 (21.7 %) patients. The average age of patients at the time of metastatic lesion verification was 55.65 ± 13.4 years, with the number of women patients prevailing (36 patients out of 66, or 54.5 %). Liver metastases were found in 63.6 %, lungs metastases, 4.5 %, multiple metastases — 31.9 % of patients. With regular follow-up, the critical period for metastasis detection was between one to five years — 77.2 % of patients with metastatic lesions and 16.8 % of the total number of the treated patients. The average time of metastasis appearance after the liquidation treatment was 27.75 ± 22.06 months, in cases of organ preservation treatment it was 61.57 ± 50.32 months. A metastatic process was diagnosed predominantly in large (63.6 %) and medium (28.8 %) CM. The risk criteria for metastatic development in CM were found to be: male gender, pre-equatorial localization, fungoid shape, large tumor size, pigmented tumor, transudative retinal detachment, mixed histopathological tumor variant.Conclusion. The established clinical and instrumental criteria of the risk of metastatic lesion in choroidal melanoma should be considered when planning follow-up monitoring of this group of patients.
Choroidal melanoma is the most common and life-threatening intraocular malignant neoplasm affecting the eye choroid in about 90 % of cases. The incidence varies from 0.7 to 1.1 per 100,000 of the population. This category of malignant neoplasms is highly aggressive in terms of local distribution, the occurrence of loco-regional and distant metastases. According to various authors, the frequency of metastasis reaches up to 50 %, the risks of metastatic disease depend on the size of the tumor, the duration of observation, clinical and pathomorphological characteristics of the choroidal melanoma and genetic factors. This article provides a detailed literature review on the developmental aspects and growth dynamics of choroidal melanoma from the point of view of neoangiogenesis and the phenomenon of vasculogenic mimicry, and the possibilities of instrumental diagnostics for determining the malignant vasculature of a tumor. The relevance of studying this issue is determined by the peculiarities of the origin of choroidal melanoma, which can occur both de novo and due to malignant transformation from nevus cells and the critical point for it is a tumor thickness of more than 2 mm, at in which the the process of neoangiogenesis starts. This review details the role of various methods of instrumental diagnostics, such as doppler ultrasound imaging to determine the presence or absence of blood flow in the tumor and its blood flow characteristics, angiography using contrasts: fluorescein and indocyanine green angiography, and optical coherent tomography—angiography to identify the malignant vasculature and evaluation of tumor angioarchitectonics. It has been shown that in the diagnosis of especially small choroid melanomas, which are of significant diagnostic complexity, a multimodal approach using the above research methods is important. There is no doubt that these instrumental technologies aimed to identify the malignant vasculature of choroidal melanoma play a large role not only in diagnosis, but also are of considerable practical interest in planning treatment, in assessing its effectiveness, and also in predicting the risks of metastatic process development.
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