Unilateral Multifocal Choroidal Melanoma

Mustafi, Debarshi; Damato, Bertil; Berry, Jesse L.

doi:10.1159/000478102

Cited by 5 publications

(5 citation statements)

References 9 publications

(9 reference statements)

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“…Regarding multifocal unilateral uveal melanoma, there have been just over 20 cases reported in the literature [14][15][16][17][18][19][20]22]. In our series, it was important to distinguish between the occurrence of a new tumor in the same eye and local recurrence.…”

Section: Discussionmentioning

confidence: 97%

“…The incidence of uveal melanoma in the USA has been estimated to be 5.1-5.2 per million [1][2][3]. Having a diagnosis of uveal melanoma more than once in a lifetime is expected to be exceedingly rare but has been reported either as bilateral melanoma [4][5][6][7][8][9][10][11][12][13], unilateral multiple/ multifocal melanoma [14][15][16][17][18][19][20][21][22], or melanoma with metastasis to the ipsilateral [21,23] or contralateral [24][25][26][27][28] eye. In this chart review, our aim is to identify any such cases among patients who have been diagnosed and treated for uveal melanoma at the Duke University Eye Center (DUEC) Ophthalmic Oncology Center.…”

Section: Introductionmentioning

confidence: 99%

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Multiple Uveal Melanoma

Kheir

Kim

Materin³

2020

Ocul Oncol Pathol

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Introduction: Multiple uveal melanoma is a rare occurrence and includes bilateral melanoma, unilateral multiple/multifocal melanoma, or melanoma with metastasis to the ipsilateral or contralateral eye. Methods: A chart review of patients diagnosed with uveal melanoma between January 2013 and January 2019 at the Duke University Eye Center Ophthalmic Oncology Service was performed. Results: Three patients with multiple, sequential melanoma were identified; patient 1 had bilateral choroidal melanoma and patients 2 and 3 had 2 choroidal melanomas occurring in the same eye. In all 3 patients, both the first and sequential choroidal melanomas were treated with I-125 radioactive plaque brachytherapy (PBT). Two patients were found to have developed secondary metastatic uveal melanoma as a presenting sign of systemic metastases. Patient 4, initially treated with PBT, was diagnosed with ipsilateral metastatic choroidal melanoma, also treated with PBT. Patient 5 had right eye enucleation for choroidal melanoma and developed vision-threatening me-tastasis in the left eye, which was treated with PBRT. None of the patients had history of cancer prior to their first diagnosis. Patients 1 and 5 were tested with a systemic melanoma panel; both were negative for BAP1, but patient 1 had a variant of unknown significance in BRCA2. Patient 3 had oculodermal melanocytosis, an established risk factor of uveal melanoma. Conclusion: Although rare, the possibility of multiple uveal melanoma does exist. Examination of the treated and contralateral eye on a regular basis is crucial, not only to identify local failure but also new metastases from the primary tumor and additional primary tumors.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Multiple Uveal Melanoma

Kheir

Kim

Materin³

2020

Ocul Oncol Pathol

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“…However, tumor regression occurs anywhere from 6 months to 2 years [ 36 ]. Most local recurrences were reported in the first 3 years after treatment, while there is a reported case of an eye that developed a second CM after 20 years [ 19 ] following PBT for UM.…”

Section: Discussionmentioning

confidence: 99%

“…UM most commonly affects adults aged 50–80 years, without a sex bias. It is predominantly unilateral [ 17 ] with bilateral choroidal melanomas (CMs) occurring in only 1 in every 50 million Caucasians [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Radiation treatment methods in uveal melanoma

Tsotridou¹,

Loukovitis²,

Tsiropoulos³

et al. 2021

Med Hypothesis Discov Innov Ophthalmol

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Background: The most frequent primary ocular malignancy in the western world is the uveal melanoma. While it mainly affects Caucasians, it is extremely uncommon among non-Caucasians. Continuous improvement in therapies for local treatment has allowed sparing of the eye, although this approach apparently does not improve survival. The present review aimed to explain different radiotherapy (RT) methods and compare the pros and cons of each method, along with the main complications that may be encountered in the treatment of uveal melanoma. Methods: Relevant papers published in English between January 2010 and January 2021 were retrieved, reviewed, and screened. Four databases, including PubMed, MEDLINE, Google Scholar, and GeneCards, were searched for this purpose. Results: Forty-one relevant articles were identified. Based on the selected papers, we highlighted the advantages and disadvantages of the different RT methods that have allowed sparing of the eye, even though they have not, as yet, improved survival. We listed a detailed comparison between therapies that allow an educated choice among the different available RT methods. Conclusions: The choice of uveal melanoma management is determined by the location of the tumor and volume of the extraocular extent. At present, there is no gold standard for the management of all ocular melanomas, and each case should be approached individually. Therefore, classification is a valuable prognostic tool. Many cases in cT3-4 classification categories are treated by primary enucleation and conservative treatment follow-up, while in cT2 and most cT1 classifications (i.e., 3.1–6.0-mm tumor thickness), several forms of RT are used. Keywords: melanoma of the uvea, choroidal melanoma, radiation therapy, brachytherapy, radioisotope brachytherapy, proton beam therapy, classification

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“…1,2 The mechanisms and risk factors leading to primary uveal melanoma continue to be elucidated. [2][3][4][5][6][7][8][9] During the last 20 years there has been widespread use of radiotherapy, either brachytherapy or charged-particle delivery for the treatment of uveal melanoma; however, significant morbidity and mortality are still associated with this disease. 10 Definitive treatment of malignant melanoma, especially small tumors, has been controversial because of the similarities with atypical uveal nevi.…”

Section: Introductionmentioning

confidence: 99%

Five-Year Follow-up of Microincisional Vitrectomy Surgery, Endolaser Tumor Ablation, and Gene-Expression Profiling in Small Uveal Melanoma

Murray

Villegas

Bach³

et al. 2020

Journal of VitreoRetinal Diseases

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Purpose: This work evaluates a microincisional vitrectomy surgical (MIVS) approach to endolaser ablation of small uveal malignant melanoma by incorporating genetic tumor classification as a means to avoid radiotherapy while maintaining local tumor control without compromising visual acuity (VA). Methods: An institutional review board–approved, single-surgeon, retrospective analysis was conducted of a consecutive case series of all patients with tumors less than 2.5 mm in apical thickness who underwent MIVS, endolaser tumor ablation, fine-needle aspiration biopsy (FNAB), and intravitreal triamcinolone acetonide for small uveal melanoma between 2012 and 2015. Results: A total of 226 patients underwent FNAB from January 2012 to January 2015 for uveal melanoma. All 58 patients treated for a small uveal melanoma were included. This group of patients had a minimum follow-up of 60 months (range, 60-93 months). At initial diagnosis, subretinal fluid was present in 52 eyes (89.1%), macular edema was present in 24 eyes (41.4%), and epiretinal membrane was present in 11 eyes (20.1%). Fifty-six specimens (96.5%) received a molecular classification of either class 2 (4 of 56, 7.1%) or class 1 (52 of 56, 92.8%). Initial VA was 20/40 or better in 26 eyes (44.8%), and final VA was 20/40 or better in 48 of 58 eyes (82.8%). Conclusions: Endolaser tumor ablation delivered at MIVS surgery enables excellent tumor control (98.3%) and improves VA to better than 20/40 in more than 80% of treated eyes. FNAB achieves molecular classification in 96.5% of all patients undergoing treatment for small choroidal melanoma independent of tumor size.

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Unilateral Multifocal Choroidal Melanoma

Cited by 5 publications

References 9 publications

Multiple Uveal Melanoma

Multiple Uveal Melanoma

Radiation treatment methods in uveal melanoma

Five-Year Follow-up of Microincisional Vitrectomy Surgery, Endolaser Tumor Ablation, and Gene-Expression Profiling in Small Uveal Melanoma

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