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

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.

Detecting Progression of Treated Choroidal Melanomas: Is Ultrasonography Necessary?

Prompt detection and treatment of local treatment failure after radiotherapy for choroidal melanoma optimises any opportunities for conserving vision and the eye, possibly reducing an increased risk of metastatic disease. Long-term surveillance is therefore required but is hampered by the perceived need to perform ultrasonography, which may not be available at a patient’s local hospital. The aim of this study was to determine whether local treatment failure can reliably be detected with colour fundus photography alone, and, if so, in which patients. Patients were included in the study if diagnosed with local treatment failure between April 2016 and February 2021 after eye-conserving therapy for choroidal melanoma. Wide-field colour and fundal autofluorescence (FAF) images, optical coherence tomography (OCT), and ultrasonography (US) were analysed by two of the authors (GN and UH). The cohort included 87 patients with local treatment failure. In 75 patients with clear media, tumour progression was detected by colour photography alone in 74 (98.7%) patients. Sensitivity was not increased by the addition of either OCT or AF. One patient with clear media developed extraocular extension detected with US without visible change in the intraocular part of the tumour. In the other 12 patients, US was required because of opaque media and a consequently poor fundal view. Local treatment failure after radiotherapy for choroidal melanoma is detected in 98.7% of cases with colour photography when the media are clear. Ultrasonography is useful when photography is prevented by opaque media or tumours having locations in the far periphery.

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

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.

A diagnostic assessment of angioarchitectonics of choroidal melanoma

Purpose: to study angioarchitectonics of choroidal melanoma with varied biometric characteristics by comparing the results of indocyanine green angiography (IAG) and OCT angiography (OCTA).Material and methods. Angiography with indocyanine green and OCT angiography was performed in 45 choroidal melanoma patients (45 eyes, 20 men, 25 women, mean age 57.36 ± 15.11 years) to see the features of angioarchitectonics for various tumor elevations: up to 3 mm (small choroidal melanomas) and within the 3.1– 5.0 mm range (medium choroidal melanomas) and assess the informative value of the techniques.Results. We established a high diagnostic value of angiography with indocyanine green and OCT angiography in the diagnosis of vasculature of choroidal melanoma (89% and 71 %, respectively), an acceptable significance in small choroidal melanomas, and a higher informative value of angiography with indocyanine green in medium choroidal melanomas. The vasculature of small choroidal melanomas is characterized by type 1 angioarchitectonics predominance (59 %), while that of medium-sized melanomas corresponds to type 2 angioarchitectonics (81 %). The pattern match in angiography with indocyanine green and OCT angiography took place in 93.8 % of patients. The average depth of vessel identification during OCT angiography was determined to stay within the range of 186 μm for choroidal melanomas of up to 1.9 mm high, 220 μm for melanomas between 2 and 3 mm high, and 255 μm for melanomas higher than 3 mm.Conclusions. The use of contrast and non-contrast angiography in assessing the vasculature of choroidal melanoma is highly informative and useful for the assessment of the type of angioarchitectonics. The use of OCT angiography is more informative for tumors with an elevation of up to 3 mm. In order to increase the accuracy and effectiveness of OCTA, the identification of newly formed vessels should be carried out with regard to the parameters established.

Correlations between OCT and histological findings in choroidal melanomas

It is known that OCT-detected retinal changes are comparable with histology resalts. Choroidal structure on EDI-OCT also comparable with histology. Purpose. To compare OCT-changes with pathomorphology in same microscopic sections. Material and methods. The analysis of OCT tomograms of 5 patients with choroidal melanomas (CM), who subsequently underwent primary enucleation. The patients age was 55,2±10,57 years. The maximum CM elevation is 4,85±1,76 mm, the maximum diameter is 13,09±4,14 mm. Results and discussion. The correlation of tomographic and histological picture was obtained in the following signs: signs of destruction of Bruch's membrane, the presence of hyperreflective changes at the RPE level, photoreceptors changes, the presence of neuroepithelial detachment, the presence of intraretinal cavities. Partial correlation - for signs of the presence of subretinal transudate and infiltration of the outer layers of the retina. No correlation was obtained for the signs of infiltration of the inner retina layers and the inner limitans membrane breakthrough with CM dissemination on a retinal surface. Conclusions. Comparison of OCT signs of MC with pathomorphological studies in 5 enucleated eyes made it possible to expand the interpretation of signs of CM spreading on OCT beyond the Bruch's membrane with the tumor growth zones formation in the retina. Key words: choroidal melanoma, optical coherence tomography of the retina, histological examination.

Distinguishing Choroidal Nevi from Melanomas Using the MOLES Algorithm: Evaluation in an Ocular Nevus Clinic

Objective: The aim of this study was to determine the sensitivity and specificity of the MOLES scoring system in differentiating choroidal melanomas from nevi according to Mushroom shape, Orange pigment, Large tumor size, Enlarging tumor, and Subretinal fluid (SRF). Methods: Color photographs, fundus-autofluorescence images, and optical coherence tomography of 222 melanocytic choroidal tumors were reviewed. Each MOLES feature was retrospectively scored between 0 and 2 and tumors categorized as “common nevus,” “low-risk nevus,” “high-risk nevus,” and “probable melanoma” according to the total score. MOLES scores were compared with the experts’ diagnosis of melanoma. Results: The MOLES scoring system indicated melanoma in all 81 tumors diagnosed as such by ocular oncologists (100% sensitivity) and nevus in 135 of 141 tumors given this diagnosis by these experts (95.7% specificity). Of the 6 tumors with discordant diagnoses, 4 had basal diameters exceeding 6 mm, all with SRF and/or orange pigment, and 2 small tumors showed either significant SRF with traces of orange pigment, or vice versa. Conclusions: The MOLES system for diagnosing melanocytic choroidal tumors compares well with expert diagnosis but needs to be evaluated when deployed by ophthalmologists and community optometrists in a wide variety of working environments.

Application of Multimodal and Molecular Imaging Techniques in the Detection of Choroidal Melanomas

Choroidal melanomas are the most common ocular malignant tumors worldwide. The onset of such tumors is insidious, such that affected patients often have no pain or obvious discomfort during early stages. Notably, enucleation is required for patients with a severe choroidal melanoma, which can seriously impact their quality of life. Moreover, choroidal melanomas metastasize early, often to the liver; this eventually causes affected patients to die of liver failure. Therefore, early diagnosis of choroidal melanomas is extremely important. Unfortunately, an early choroidal melanoma is easily confused with a choroidal nevus, which is the most common benign tumor of the eye and does not often require surgical treatment. This review discusses recent advances in the use of multimodal and molecular imaging to identify choroidal melanomas and choroidal nevi, detect early metastasis, and diagnose patients with choroidal melanomas.