scholarly journals Сombined Treatment of Juxtaand Parapapillary Choroidal Melanoma

2020 ◽  
Vol 17 (2) ◽  
pp. 195-201
Author(s):  
V. V. Neroev ◽  
S. V. Saakyan ◽  
А. G. Amiryan ◽  
V. V. Valskiy ◽  
А. Iu. Tsygankov
Keyword(s):  
Optic Disc ◽  
Combined Treatment ◽  
Local Treatment ◽  
Flow Analysis ◽  
Choroidal Melanoma ◽  
Laser Coagulation ◽  
Basal Diameter ◽  
Tumor Focus ◽  
Choroidal Melanomas

Purpose. Estimation the local efficacy of the combined treatment — brachytherapy (BT) with laser coagulation (LC) in choroidal melanomas of juxta and parapapillary localization in the long-term follow-up. Patients and Methods. In 2009–2013, 50 patients with choroidal melanoma of juxta and parapapillary localization were examined and treated, 32 women and 18 men aged from 32 to 76 years old (average — 53.8 ± 9.6 years). The averaged tumor height was 3.8 ± 1.3 mm, basal diameter — 11.2 ± 2.4 mm. The combined organ-preserving treatment included a LC from the optic disc with subsequent BT was performed. The indications for this method were choroidal melanomas of juxta and parapapillary localization (the distance between the optic disc and the central border of the tumor was no more than 1.5 pd), with the absence of subretinal exudate and retinal detachment in this zone. The follow-up period after the combined treatment ranged from 18 to 102 months (Me = 60 months). Results. Complete tumor resorption was achieved in the majority — 38 (76.0 %) of cases, partial — in 11 (22.0 %) patients, stabilization of the process — only in one (2.0 %) patient, continued growth was not observed in any patient. The initial size of melanoma in patients with complete and partial tumor resorption showed similar averaged values, amounting to 3.8 ± 1.3 mm and 3.6 ± 1.1 mm (p > 0.05), respectively, basal diameter — 11.1 ± 2.4 mm and 11.4 ± 2.4 mm (p > 0.05), respectively. According to the duplex scanning, an increase in the distribution density of bloodflow in the projection of the tumor focus was noted compared with the initial data. In the spectral Doppler flow analysis study, an increase in the linear characteristics of the blood flow in the tumor’s own vessels after LC was recorded. Complications included optic neuropathy (88 %), hemorrhage (36 %) and secondary glaucoma (6 %). Conclusions. The combined treatment allowed to achieve high therapeutic results — 76.0 % of the total resorption of choroidal melanomas, which have unfavorable localization for BT. Given the main focus of local treatment of the choroidal melanoma on its destruction, this technique can be used to increase the effectiveness of the BT of choroidal melanomas of juxta and parapapillary localization.

Primary photodynamic therapy for small amelanotic choroidal melanomas: consecutive case series of 69 patients with at least 24-month follow-up

2020 ◽  
pp. bjophthalmol-2020-316616
Author(s):  
Hibba Quhill ◽  
Daniel Gosling ◽  
Katharine Sears ◽  
Paul Rundle
Keyword(s):  
Photodynamic Therapy ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Retrospective Case ◽  
Recurrence Rates ◽  
Basal Diameter ◽  
Visual Outcomes ◽  
Choroidal Melanomas ◽  
The Mean

AimsTo investigate the success and recurrence rates and visual outcomes in a large case series of amelanotic posterior choroidal melanomas treated by means of primary photodynamic therapy (PDT) with verteporfin.MethodsRetrospective case series from a single specialist ocular oncology centre. All patients had a clinical diagnosis of choroidal melanoma and were selected for PDT based on tumour characteristics. Included patients had at least 24 months of follow-up from initiation of treatment and all but one had not received treatment prior to PDT.Results69 patients were included. Mean tumour thickness was 1.9 mm (range 0.5–4.4), while the mean basal diameter was 6.9 mm (range 2.4–11.0). Included lesions were stage cT1a (n=66) or cT2a (n=3). The mean duration of follow-up from treatment initiation was 57 months (range 24–116 months). Seven lesions (10%) failed to respond to PDT. 10 patients (16%) experienced recurrence during follow-up. Overall success rate in this series was 75% (n=52). 83% of successfully treated patients (n=43) maintained or gained vision by final follow-up. Visual outcomes were significantly better in those patients who received PDT therapy alone in comparison to those who needed other treatments for their melanoma (Fisher’s exact test, p=0.004). Unfortunately, one patient (1.4%) in the series developed systemic metastases and died.ConclusionSelected amelanotic posterior uveal melanomas may be successfully treated with PDT with retention of good vision in the majority of cases, maintained with a mean of 57 months (minimum of 24 months) of follow-up.

Small choroidal melanoma: outcomes following apical height dose brachytherapy

2020 ◽  
pp. bjophthalmol-2020-316873
Author(s):  
Renato Jose Yupari ◽  
James Bena ◽  
Allan Wilkinson ◽  
John Suh ◽  
Arun Singh
Keyword(s):  
Survival Rate ◽  
Tumour Size ◽  
Choroidal Melanoma ◽  
Basal Diameter ◽  
Small Tumour ◽  
Prior Therapy ◽  
Kaplan Meier ◽  
Choroidal Melanomas ◽  
The Mean ◽  
Iodine 125

AimTo assess the outcomes of small choroidal melanoma following iodine-125 episcleral brachytherapy (apical height dose of 85 Gy).MethodsPatients with small choroidal melanoma that underwent iodine-125 episcleral brachytherapy between January 2004 and December 2017 were reviewed. Inclusion criterion for this study was the COMS small tumour size (tumour apical height of 1.0–2.5 mm and largest basal diameter (LBD) <16.0 mm). Patients that received any form of prior therapy or adjuvant transpupillary thermotherapy were excluded. Outcome measures were visual acuity (VA), recurrence, ocular survival and metastasis at 3 years. Kaplan-Meier estimation was calculated for VA, recurrence, ocular survival and survival outcome (overall and metastasis-free survival rate) at 3 years.Results161 cases of choroidal melanoma were included in this study, with the mean (SD) age of 59.6 (14.1) years, and 93 (58%) were males. The mean (SD) apical height for the tumours were 2.1 (0.4) mm and mean (SD) LBD was 8.3 (2.2) mm. The mean (SD, median) follow-up was 40.7 months (37.1, 25 months). The VA was 20/50 or better in 69%. Only one recurrence event (1%) and one enucleation event (1%) were observed. Overall survival was 97%, and no metastatic events were observed at 3 years.ConclusionSmall choroidal melanomas treated with iodine-125 episcleral brachytherapy have excellent outcomes. The majority (69%) of patients retained VA of 20/50 or better with very high local control and ocular survival rate (99.3%) with the absence of metastasis (100%).

Presumed incipient choroidal melanoma: proposed diagnostic criteria and management

2021 ◽  
pp. bjophthalmol-2020-318658
Author(s):  
Susanna Jouhi ◽  
Ranaa T Al-Jamal ◽  
Martin Täll ◽  
Sebastian Eskelin ◽  
Tero T Kivelä
Keyword(s):  
Growth Rate ◽  
Diagnostic Criteria ◽  
De Novo ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Published Data ◽  
Basal Diameter ◽  
Long Term Follow Up ◽  
Uveal Melanomas

AimsTo propose diagnostic criteria for a presumed incipient choroidal melanoma based on tumour growth rate and tumour doubling time (TDT) and to describe management of such tumours with transpupillary thermotherapy (TTT).MethodsRetrospective interventional case series of nine consecutive presumed incipient uveal melanomas diagnosed and treated with TTT in 2010–2017. Growth rate in mm/year and per cent/year in largest basal diameter (LBD) and TDT were compared with published data for uveal melanomas and growing naevi that did not transform to melanoma under long-term follow-up.ResultsThe median LBD and thickness were 1.6 mm (range 0.9–2.3) and 0.20 mm (range 0.15–0.29), respectively. The median age was 57 years (range 47–78). Seven tumours were classified as de novo melanomas and two as transformed naevi. The median time from first observation to diagnosis was 3.3 years (range 2.2–7.3), LBD growth rate 0.25 mm/year (range 0.11–0.72) and 34 per cent/year (range 10–1437), and TDT 609 days (range 97–1612). The estimates matched those reported for uveal melanoma (median TDT 521 days, 90th percentile 2192) and exceeded those for growing naevi (median growth rate 0.04 mm/year, 90th percentile 0.12; 1.1 per cent/year, 90th percentile 2.6). The predicted median age at de novo appearance was 51 years (range 32–63). No tumour grew after TTT during a median follow-up of 2.1 years (range 0.6–8.7).ConclusionsIn this series, relative growth rate and TDT best qualified as diagnostic criteria for an incipient choroidal melanoma. Too small for brachytherapy, they could be managed with TTT.

Effect of Pre-Enucleation Radiation on Mortality in Large Choroidal Melanomas

2020 ◽  
pp. 257-262
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Choroidal Melanoma ◽  
External Beam Radiation ◽  
External Beam ◽  
External Radiation ◽  
Beam Radiation ◽  
Basal Diameter ◽  
Choroidal Melanomas ◽  
Large Primary

The Collaborative Ocular Melanoma Study (COMS) was a randomized clinical trial in patients with unilateral, large primary choroidal melanoma, defined as 2.0 mm or greater in apical height and greater than 16.0 mm in longest basal diameter, or greater than 10.0 mm in apical height regardless of the basal dimensions, to determine whether pre-enucleation external radiation to the globe and orbit significantly prolongs a patient’s lifespan compared to standard enucleation alone. The study showed that pre-enucleation external-beam radiation (20 Gy) did not improve survival compared with enucleation alone, although it did reduce the risk of orbital recurrence. This study established the appropriateness of primary enucleation alone in managing large choroidal melanomas not amenable to globe-conserving therapy.

scholarly journals Isolated choroidal melanocytosis: clinical update on 37 cases

2020 ◽  
Vol 258 (12) ◽  
pp. 2819-2829
Author(s):  
James J. Augsburger ◽  
Cassandra C. Brooks ◽  
Zelia M. Correa
Keyword(s):  
Choroidal Melanoma ◽  
Initial Diagnosis ◽  
Adult Patients ◽  
Basal Diameter ◽  
Orange Pigment ◽  
Fellow Eye ◽  
Retrospective Clinical Study ◽  
Choroidal Malignant Melanoma ◽  
Choroidal Nevus

Abstract Purpose Isolated choroidal melanocytosis is a congenital melanocytic hyperpigmentation involving the choroid that is not associated with iridic or scleral features of ocular melanocytosis. The purpose of this work was to describe the clinical features and course of a relatively large series of patients with this disorder. Methods A retrospective clinical study of 37 patients with isolated choroidal melanocytosis encountered in a single practice 1986–2018 was done. All lesions were 5 mm or larger in the largest basal diameter, homogeneously melanotic, and completely flat by conventional ocular ultrasonography. Results The 37 patients ranged in age from 2 weeks to 87 years (mean 31.5 years, median 18 years) at initial diagnosis of the melanotic choroidal lesion. Arc length largest basal diameter of the melanotic choroidal lesion ranged from 5.5 to 37 mm (mean 14.6 mm, median 13 mm). The lesion extended beneath the fovea in 18 eyes and to the optic disc margin in 6 eyes. Ten of the lesions straddled the ocular equator, but the center point of all of the lesions was posterior to the equator. The retina was fully attached and appeared normal over the melanotic choroidal lesion in each of these eyes. None of the melanotic choroidal lesions exhibited clumps of orange pigment or drusen on its surface. The lesion was unilateral and unifocal in 36 of the 37 patients. One patient had bilateral choroidal melanocytosis that was isolated in one eye but associated with partial iris melanocytosis in the fellow eye. Three adult patients had a choroidal melanoma localized to the patch of choroidal melanocytosis at baseline. One other adult patient had a choroidal melanoma in the fellow eye at baseline. One pediatric patient had viable unilateral non-familial retinoblastoma in the fellow eye and two adult patients had a classic choroidal nevus in the fellow eye. None of the flat patches of choroidal melanocytosis that were monitored periodically after initial diagnosis expanded appreciably during follow-up ranging from 4.9 months to 15.2 years (mean 5.0 years, median 2.3 years). Conclusions Isolated choroidal melanocytosis is a distinct clinical entity that must be distinguished from broad-based choroidal nevus, choroidal melanocytoma, small choroidal malignant melanoma, acquired bilateral patchy-streaky choroidal melanocytic fundopathy associated with disorders such as cutaneous vitiligo and Waardenburg syndrome, acquired bilateral zonal choroidal melanocytic fundopathy, and diffuse uveal melanocytic proliferation associated with systemic cancer. This disorder appears to predispose affected eyes to development of choroidal melanoma arising from the hypermelanotic patch.

Hypertensive Gas Technique for Enucleation of Choroidal Melanomas: A Preliminary Report

1992 ◽  
Vol 2 (1) ◽  
pp. 30-32
Author(s):  
I. Kreissig ◽  
B. Jost
Keyword(s):  
Choroidal Melanoma ◽  
Inclusion Criteria ◽  
Epithelioid Cells ◽  
Base Diameter ◽  
Simple Alternative ◽  
Choroidal Melanomas ◽  
Melanoma Patients ◽  
A Prospective Study ◽  
Previous Irradiation

The hypertensive gas technique induces avascularity within the eye during enucleation of a melanoma. Before touching the eye for enucleation, pressure is raised to maximum by an intravitreal injection of approximately 1.4 ml of gas (perfluorocarbon, air) resulting in a rock-hard eye. Avascularity persists for the duration of enucleation. From 9/1987 to 6/1989, 15 patients with choroidal melanomas were enrolled in a prospective study with the hypertensive gas technique instead of prior radiotherapy (the death rate in that series was five out of 26 melanoma patients at three years). Inclusion criteria for the hypertensive gas technique study were the same as for our previous irradiation series: (1) absence of detectable metastases and (2) a choroidal melanoma too large for a radioactive plaque. The average base diameter of melanomas measured 13.2 mm, height 8.4 mm. The cytology was: 11x spindle, 3x mixed, 1x epithelioid cells. At re-examination in 7/1991 (average follow-up 33 months) two diabetics had died with no detectable metastases prior to death, and one of the 15 melanoma patients had died with metastases 24 months after enucleation. So far the hypertensive gas technique for enucleation of a melanoma eye seems to have no adverse effect on survival. It seems to be a simple alternative to the precautions taken otherwise and it facilitates enucleation with pratically no bleeding from the globe.

scholarly journals Polypoidal Choroidal Vasculopathy Associated with Optic Disc Coloboma

2018 ◽  
Vol 9 (1) ◽  
pp. 98-101 ◽  
Author(s):  
Yumiko Nakano ◽  
Akiko Miki ◽  
Shigeru Honda ◽  
Makoto Nakamura
Keyword(s):  
Optic Disc ◽  
Polypoidal Choroidal Vasculopathy ◽  
Combined Treatment ◽  
Serous Retinal Detachment ◽  
Vascular Endothelial ◽  
Optic Disc Coloboma ◽  
Temporal Side ◽  
Endothelial Growth Factor ◽  
Choroidal Vasculopathy

Purpose: To report a case of polypoidal choroidal vasculopathy associated with optic disc coloboma. Methods: Case report. Results: A 50-year-old woman presented with optic disc coloboma and retinochoroidal coloboma associated with subretinal hemorrhage and serous retinal detachment (SRD) in her left eye. Optical coherence tomography (OCT) confirmed SRD at the macula and showed a sharply elevated retinal epithelial detachment at the choroidal excavation. OCT also revealed choroidal cavitation along the temporal side of the optic coloboma. Fluorescein angiography showed hyperfluorescent dye leakage and indocyanine green angiography revealed polypoidal lesions. We diagnosed polypoidal choroidal vasculopathy (PCV). PCV was located at the end of the choroidal cavitation. Her left eye was treated with an intraocular injection of the anti-vascular endothelial growth factor aflibercept (2 mg). Photodynamic therapy was performed using the standard protocol 1 week after the intravitreal application of aflibercept. One month after the combined treatment, OCT showed completely resolved SRD and her symptoms disappeared. Her best-corrected visual acuity remained stable and no recurrence was found during a 12-month follow-up period. Conclusion: PCV associated with optic disc coloboma has not been previously reported. The morphological abnormality of choroidal cavitation and choroidal excavation connecting with optic disc coloboma may contribute to the development of PCV in this case.

scholarly journals No Differences in the Long-Term Prognosis of Iris and Choroidal Melanomas when Adjusting for Tumor Thickness and Diameter

2021 ◽  
Author(s):  
Shiva Sabazade ◽  
Christina Herrspiegel ◽  
Viktor Torgny Gill ◽  
Gustav Stålhammar
Keyword(s):  
Cumulative Incidence ◽  
Case Series ◽  
Tumor Diameter ◽  
Basal Diameter ◽  
Choroidal Melanomas ◽  
Long Term Prognosis ◽  
Survival Differences ◽  
Related Mortality

Abstract Objective:To assess the long-term prognosis for patients with iris melanomas and compare it with the prognosis for small choroidal melanomas.DesignRetrospective observational case seriesMethodsAll patients treated for iris melanomas at a single referral institution between January 1st 1986 and January 1st 2016 were included. Patients treated for small choroidal melanomas during the same period were included for comparison. The cumulative incidence of melanoma-related mortality was calculated. Patient and tumor characteristics and size-adjusted hazard ratio (HR) for melanoma-related mortality were compared between iris and small choroidal melanomas.ResultsForty-five iris melanomas and 268 small choroidal melanomas were included. Twenty-four iris melanomas (53 %) had been treated with local resection, 12 (27 %) with Ruthenium-106 brachytherapy, 7 (16 %) with enucleation and 2 (4 %) with proton beam irradiation. Twenty-three patients had deceased before the end of follow-up. Median follow-up for the 22 survivors was 13.3 years (SD 9.4, table 1). Patients with iris melanomas were more often asymptomatic at presentation and had a trend towards significantly lower age (59 versus 63 years, Student’s T-tests p=0.057). Further, iris melanomas had significantly smaller basal diameter (5.8 versus 8.0 mm, p< 0.0001) and tumor volume (79 mm3 versus 93 mm mm3, p< 0.0001) but greater thickness (3.0 versus 2.5 mm, p< 0.0001). The cumulative incidence of iris melanoma-related mortality was 5 % at 5 years after diagnosis, and 8 % at 10, 15 and 20 years. The incidence was not significantly different to small choroidal melanomas (Wilcoxon p=0.46). In multivariate Cox regression with tumor diameter and thickness as covariates, patients with choroidal melanomas did not have increased HR for melanoma-related mortality (HR 2.2, 95 % CI 0.5 – 9.6, p=0.29). Similarly, there were no significant survival differences in matched subgroups (Wilcoxon p=0.82).ConclusionsThere are no survival differences between iris and choroidal melanomas when adjusting for tumor size. The reason for the relatively favorable prognosis of iris melanomas compared to melanomas of the choroid and ciliary body is likely that they are diagnosed at a smaller size.

scholarly journals Transpupillary thermotherapy of choroidal melanoma

2020 ◽  
Vol 9 (2) ◽  
pp. 29-35
Author(s):  
L. V. Naumenko
Keyword(s):  
Tumor Regression ◽  
Radiation Power ◽  
Choroidal Melanoma ◽  
Single Session ◽  
Transpupillary Thermotherapy ◽  
Entire Surface ◽  
Tumor Focus ◽  
Complete Tumor

A retrospective analysis of the immediate and long-term effectiveness of the treatment of the choroidal melanoma using transpupillary thermotherapy (TTT) was carried out. The study included 84 patients with choroidal melanoma (C69.3) who received treatment between 2007 and 2018. Patients were sampled from the Belarusian Cancer Register. The average values of the thickness of the tumor were 2.6±1.3 mm, the diameter of the base - 7.2±3.3 mm. TTT was carried out using a diode laser with a wavelength of 860 nm and radiation power of 200 - 800 mW, the exposure time was 60 s, and the diameter of the laser spot was varied between 1 and 3 mm. The entire surface of the tumor was thermally treated with overlapping fields from the periphery to the top. 75 patients underwent a single session of TTT, while 9 - two sessions with an interval of 3–4 weeks. As a result of the treatment, 51 (60.7%) patients showed complete tumor resorption, 28 (33.3%) patients had stabilization of the tumor process, and 5 (6.0%) patients had no effect. In the group of patients with stabilization of the tumor process, continued growth was recorded in 16 (19.1%) patients with follow-up periods of 3 months to 4 years. In 19 (37.3%) patients from the group with complete tumor regression, relapse was observed 1 to 8 years after TTT. Metastatic disease (disease progression) developed in 5 (5.9%) patients, of which in 1 patient during the first 12 months, in 1 patient - after 4 years, and in 3 patients more than after 5 years of the follow-up observation. Analysis of the effectiveness of TTT of choroidal melanoma showed that an increase in the thickness and diameter of the base of the tumor focus results in the decrease of immediate effectiveness, and the rise of the likelihood of continued tumor growth.

scholarly journals No differences in the long-term prognosis of iris and choroidal melanomas when adjusting for tumor thickness and diameter

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shiva Sabazade ◽  
Christina Herrspiegel ◽  
Viktor Gill ◽  
Gustav Stålhammar
Keyword(s):  
Cumulative Incidence ◽  
Case Series ◽  
Tumor Diameter ◽  
Basal Diameter ◽  
Choroidal Melanomas ◽  
Long Term Prognosis ◽  
Survival Differences ◽  
Related Mortality

Abstract Objective To assess the long-term prognosis for patients with iris melanomas and compare it with the prognosis for small choroidal melanomas. Design Retrospective observational case series. Methods All patients treated for iris melanomas at a single referral institution between January 1st 1986 and January 1st 2016 were included. Patients treated for small choroidal melanomas during the same period were included for comparison. The cumulative incidence of melanoma-related mortality was calculated. Patient and tumor characteristics and size-adjusted hazard ratio (HR) for melanoma-related mortality were compared between iris and small choroidal melanomas. Results Forty-five iris melanomas and 268 small choroidal melanomas were included. Twenty-four iris melanomas (53%) had been treated with local resection, 12 (27%) with Ruthenium-106 brachytherapy, 7 (16%) with enucleation and 2 (4%) with proton beam irradiation. Twenty-one (68%), 7 (16%) and 2 (4%) of the iris melanomas were of the spindle, mixed and epithelioid cell types, respectively. Twenty-three patients had deceased before the end of follow-up. Median follow-up for the 22 survivors was 13.3 years (SD 9.4). Patients with iris melanomas were more often asymptomatic at presentation and had a trend towards significantly lower age (59 versus 63 years, Student’s T-tests p = 0.057). Further, iris melanomas had significantly smaller basal diameter (5.8 versus 8.0 mm, p < 0.0001) and tumor volume (79 mm3 versus 93 mm mm3, p < 0.0001) but greater thickness (3.0 versus 2.5 mm, p < 0.0001). The cumulative incidence of iris melanoma-related mortality was 5% at 5 years after diagnosis, and 8% at 10, 15 and 20 years. The incidence was not significantly different to small choroidal melanomas (Wilcoxon p = 0.46). In multivariate Cox regression with tumor diameter and thickness as covariates, patients with choroidal melanomas did not have increased HR for melanoma-related mortality (HR 2.2, 95% CI 0.5–9.6, p = 0.29). Similarly, there were no significant survival differences in matched subgroups (Wilcoxon p = 0.82). Conclusions There are no survival differences between iris and choroidal melanomas when adjusting for tumor size. The reason for the relatively favorable prognosis of iris melanomas compared to melanomas of the choroid and ciliary body is likely that they are diagnosed at a smaller size.

Sign in / Sign up

Export Citation Format

Share Document