This case series assesses whether the eighth edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual can be used to accurately estimate mortality rates of conjunctival melanoma.

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Purpose To analyze in uveal melanomas (UM) the expression of angiogenic factors in pre‐ and post‐treatment neovascular glaucomas (NVG). To study Vascular Endothelial Growth Factor (VEGF‐A; VEGFxxxb) and interleukin 8 (IL‐8) levels in the aqueous humor of eyes with UM prior to treatment. Methods The cytokines rates in UM have been studied by performing anterior chamber tap. In a few cases, we also analyzed these rates both in vitreous (V) and aqueous (A) humors to compare their concentrations. In addition, some control measurements were made. The concentrations were determined using dedicated enzyme‐linked immunosorbent assay kits (ELISA) with a threshold of 5pg/ml. Results We have found no VEGF‐A in A humor of control patients. Regarding our samples, virtually no VEGFxxxb isoforms were detected in V and A humors. Moreover, production of cytokine IL‐8 was found in a few tumors producing or not VEGF. In the first series on patients with NVG, we have collected 11 samples of A humor and 5 of V humor. The VEGF‐A concentrations between A and V humor were nearly equivalent. Concerning A humor samples, VEGF‐A levels were ranged from 70.1 to 5680 pg/ml. The second series was obtained with A humor samples from 31 UM eyes prior to treatment. VEGF‐A levels were ranged from undetectable to 1532 pg/ml. The correlation between VEGF‐A levels and the different tumor features was studied. In both series, the highest rates of VEGF‐A were found in A humor of NVG UM eyes. Conclusion VEGF‐A and IL‐8 can be produced in the context of UM. However, their expression is not systematic. Our results suggest that VEGF determination should be determined prior to anti‐VEGF therapy in order to prevent post‐protontherapy complications or to improve protontherapy efficiency.

Purpose To study the prognosis of the different types of uveal melanoma recurrences treated by proton beam therapy Methods This retrospective study analyzed 61 cases of uveal melanoma local recurrence on a total of 1102 patients treated with protontherapy between June 1991 and December 2010. Survival rates have been determined by using Kaplan‐Meier curves. Prognostic factors have been evaluated by using Log‐rank test or Cox model. Results Our local recurrence rate was 5.5%. These recurrences were divided into: 25 patients with marginal recurrences, 18 global recurrences, 12 far recurrences and 6 extra‐scleral extensions. 4 factors have been identified as statistically significant risk factor of local recurrence in univariate analysis: large tumoral diameter, weak tumoral volume, weak ratio of tumoral volume over eyeball volume and safety margin inferior to 1 mm. In the local recurrence free population, the overall survival rate was 59.8% at 15 years and the specific survival rate was 80.9% at 15 years. In the local recurrence population, the overall survival rate was 34.5% at 15 years and the specific survival rate was 55% at 15 years. Kaplan‐Meier survival curves have shown a better prognosis for marginal recurrences compared to the other recurrences. Conclusion Survival rate of marginal recurrences is highly superior to the other recurrences. The type of recurrence is an important clinical prognostic value to know.

Purpose To evaluate the efficacy and safety over one year of follow‐up of dexamethasone 0.7mg intravitreal implant in patients with radiation macular edema (ME) after proton beam therapy for choroidal melanoma Methods Five patients’ charts were retrospectively reviewed. Results All patients received a radiation dose of 60 cobalt Gray equivalent. Radiation ME occurred within a mean time of 26 months after irradiation. Mean preinjection VA was 41 ETDRS letters. Two months after injection, mean VA was 47 ETDRS letters. It improved for 3 patients (+4; +9 and +15 letters) and remained unchanged for 2. Mean CRT was 331 µm. Over one year of follow‐up, two patients underwent 2 injections of dexamethasone performed 5 months after the first injection. The gain of VA was +8 and +23 letters with a decrease in CRT of 158 and 262 µm respectively. Intraocular pressure increased for 1 patient. One patient was enucleated due to a local recurrence of his choroidal melanoma. Another patient presented with a radiation neuropathy with a great loss of visual acuity. Conclusion Intravitreal dexamethasone implant can improve VA in radiation ME. Its beneficial effect lasted up to 5 months. Other causes of vision loss may jeopardize this beneficial effect.

Purpose To evaluate the outcomes of patients with recurrent uveal melanoma, treated by a second course of fractionated proton beam therapy (PBT) or by enucleation Methods Tumor recurrence was documented in 54 patients treated with PBT for uveal melanoma. Of these patients, 26 received a second course of PBT and 22 underwent enucleation. The mean patient age was 60,4 years (range, 27–85 years). Among patients with recurrence, the mean followup time was 5,8 years (range, 6 months–16,4 years). The mean visual acuity was 4,5/10 initially. All patients received 60 cobalt Gray equivalent for both courses. 24 recurrences occurred at the margin. The tumor regrowth was within the irradiated area in 17 patients (global recurrence), through the sclera in 4 patients (extra sclera extension), and completely outside the irradiated area in 9 patients. Results The 5‐year cumulative rate of local recurrence after the second treatment was 7,69 % (2 patients among 26 reirradiation). There had 5 enucleations (19,3%) among 26 reirradiations. A third of reirradiated patients maintained useful vision after a second course of PBT : 39% had 20/200 vision or better after the second treatment. The Kaplan‐Meier overall survival rate is better with Proton Beam Therapy (PBT) VS Enucleation ( p<0,02) Conclusion A second course of PBRT for recurrent uveal melanoma was associated with a relatively good probability of local control and a low enucleation rate. This retrospective analysis suggests that survival in reirradiated patients is not compromised by administration of a second course of PBT for recurrent uveal melanoma.