Utility of a Biopsy in Suspicious Pigmented Iris Tumors

Abstract

Background: In the presence of pigmented iris lesions evocative of malignant melanoma and implying oncological treatment, a foregoing biopsy to exclude a benign lesion may seem a reasonable approach. After examining patient files, the utility of such a diagnostic approach was explored. Material and Methods: Retrospective, consecutive histopathologic case series of 10 pigmented iris tumor specimens excised since 1993. Histopathologic diagnosis was compared with final diagnosis and outcome in the patient’s medical chart. Results: Five biopsies had only nevus cells, whereas ulterior clinical data or histopathologic examinations were compatible with the diagnosis of malignant melanoma. One biopsy contained insufficient sample tissue. Four biopsies confirmed clinical suspicion of iris melanoma. Conclusion: In the current case series, 6 out of 10 biopsies provided a falsely reassuring negative or an inconclusive result. Modern management techniques such as ultrasound biomicroscopy and proton therapy of the whole anterior segment have equally diminished indications for a biopsy. In cases clinically evocative of iris melanoma, a biopsy has only a relative value.

Multifocal iris melanoma treated with total anterior segment palladium-103 plaque radiation therapy

“…The diagnosis is made by clinical examination or biopsy. [1] Unifocal melanomas can be resected or treated with radiation. [2,3] Multifocal and diffuse tumors are commonly treated by enucleation, however such tumors have been treated by proton beam or iodine-125 plaque brachytherapy.…”