Primary iris melanoma: diagnostic features and outcome of conservative surgical treatment

Abstract

Aims-To describe features influencing the management of primary iris melanoma and report the outcome of conservative surgical treatment of patients diagnosed with this condition in a tertiary referral academic setting over a 20 year period. Methods-Retrospective non-comparative case series of consecutive patients diagnosed with iris melanoma from 1980-2000 using medical records from the University of Sydney Department of Ophthalmology and NSW Cancer Registry Results-51 cases were identified. The most common presentation was growth of a previously noted pigmented lesion. Initial management was either observation or local resection (two had enucleations) with iris reconstruction where possible (23.8%). The mean follow up was 8.7 years (range 1-17 years). Vision of 6/12 or better was maintained in the majority (78.6%) treated by local resection. Pupil reconstruction significantly reduced reported postoperative glare symptoms. Four patients had features suggestive of local recurrence and there was no documented metastatic disease or death from iris melanoma in this series. Histologically, the majority were spindle B cell melanomas. Clinical features including prominent tumour vascularity, rapid growth, and heterogeneous pigmentation were each significantly associated with an epithelioid cell component. Involvement of the iridocorneal angle was frequently associated with ciliary body invasion. Conclusions-Management decisions for iris melanoma will depend on the clinical features. Mixed or epithelioid histology is more likely in the presence of two or more of the features of malignancy and may justify earlier intervention. When treatment is undertaken, local resection achieves long term tumour clearance with an acceptable morbidity. In resecting iris melanoma, careful assessment for iridocorneal angle involvement is important in treatment planning. Iris reconstruction has a useful role in reducing postoperative photophobia. (Br J Ophthalmol 2001;85:848-854)

Don’t it make my blue eyes brown: heterochromia and other abnormalities of the iris

“…Iris melanomas are uncommon and account for only between 2 to 5% of all uveal melanomas. 330,331 Despite their relative rarity, iris melanomas remain an enigma and controversy surrounds both their diagnosis and management. Most studies indicate that the mean age of presentation for iris melanomas is 40-45 years: a decade earlier than their posterior uveal counterparts.…”

“…Pupil distortion, ectropion uveae, localised cataract, iridocorneal angle involvement, pigment dispersion, raised intraocular pressure, and spontaneous hyphaema may be found in iris melanomas. 284,330 Diffuse iris melanomas are extremely rare, accounting for 7-10% of all iris melanomas. 330,333 Clinically, diffuse iris melanomas classically present as a patient with unilateral hyperchromatic heterochromia and ipsilateral glaucoma.…”

“…284,330 Diffuse iris melanomas are extremely rare, accounting for 7-10% of all iris melanomas. 330,333 Clinically, diffuse iris melanomas classically present as a patient with unilateral hyperchromatic heterochromia and ipsilateral glaucoma. [333][334][335] In affected cases the iris has a diffuse or multifocal pigmentation.…”

“…Most studies indicate that the mean age of presentation for iris melanomas is 40-45 years: a decade earlier than their posterior uveal counterparts. [330][331][332] Iris melanomas may be either circumscribed or diffuse, and in both forms the clinical distinction between a melanoma and benign naevus may be difficult.…”

Proton beam therapy for iris melanomas

“…Surgical resection is associated with a risk of immediate haemorrhagic or infectious complications, or, in the longer term, may cause raised intraocular pressure and bothersome photophobia in the absence of pupillary reconstruction. 9 Furthermore, the initial management of the tumour did not appear to be a risk factor for the development of metastases in the study by Shields et al, 2 who propose surgical resection in 60% of their patients with iris melanoma.…”