Choroidal Melanoma: Our Experience

Abstract

Background: Choroidal melanomas are diagnosed in approximately 6 out of one million Americans per year, and although their incidence is low, they are the most common primary intraocular tumor in adults.
 Methods: Choroidal melanoma is rare tumors and till date no such reports with sclera involvement has been reported from Nepal. It is a prospective case series. The aim of this study is for awareness of the severity of the Choroidal melanoma and it’s management. Besides, it is also to study the demography, presentation, histopathological variations and management of cases of choroidal melanoma. All the consecutive cases of Choroidal melanoma presenting between Jan 2017 to May 2018 and those who were within the inclusion criteria were included in this study.
 Results: There were eight patients, five male and three female, within age range of 18-73, median age was 47. All patients presented with decreased vision ranging from 6/24 to PL of less then three months to 2 years duration. Fund us showed choroidal mass associated with Vitreous hemorrhage (VH), and retinal detachment (RD). Two patients were managed with enucleation with External beam radiotherapy (EBRT). Four underwent only enucleation. One patient with lesion size less then 10mm under went plaque brachy therapy. One patient underwent initially Plaque brachy therapy but later had to undergo Enucleation. Histopathological examination (HPE) of enucleated patient revealed epitheloid cell melanoma grade three in four and Spindle cell melanoma in three patients. Each one patient of epitheloid cell melanoma and spindle cell melanomahad scleral involvement. Indication for radiotherapy was scleral involvement.
 Conclusion: With 8 cases of Choroidal melanoma in a single year in a single hospitalgives us a clue that there may be much more undiagnosed cases of Choroidal melanomain Nepal that should be taken seriously. Going for annual eye examination with routine dilated fund us exams can help in prevention and early diagnosis of this life and sight threatening condition and to reduce the mortality rate.

Uveal Melanoma in Asians: A Review

“…The mean age of presentation is around 42.9-63.5 years in Asians according to different studies [4][5][6][7][8][9][10][11][12][13][14][15][16]. Only 2 studies conducted in Japan and Israel have shown mean presenting age above 60 years [7,8].…”

LiCl induces apoptosis via CHOP/NOXA/Mcl-1 axis in human choroidal melanoma cells

“…Despite successful eradication of the tumour, up to 50% of choroidal melanoma patients develop metastatic disease (typically to the liver) [2]. Due to its latency and metastatic potential, the mortality of choroidal melanoma is approximately 50% [3]. Once choroidal melanoma metastasizes, the median survival time after detection of the first metastasis is 8 months [4].…”

Magnetic Resonance Imaging Diagnosis of Choroidal Melanoma

“…However, the epithelioid confers the worst prognosis and is more commonly observed in metastases. The mixed melanoma subtype is thought to represent a transitional phenotypic entity [2][3]. Predictors of tumor behavior associated with poor prognosis are well established; size >15 mm in the maximal linear dimension of tumor growth, necrosis, depth of invasion, scleral and ciliary body involvement, anterior and juxtapapillary locations, extrascleral tumor extension, cytologic and cytogenetic features (gain of chromosome 8 and loss of chromosome 3) [1][2][3][4].…”