Ciliary Body Melanoma
Melanoma involving the ciliary body is a rare tumor that carries a poor prognosis. In some cases, diagnosis may be difficult because of similarity to other eye diseases. The differential diagnosis of ciliary body melanoma should be considered in cases of unilateral pigmentary glaucoma and chronic uveitis.
Ultrasound biomicroscopy can be used to evaluate tumor shape, thickness, margins, reflectivity, and local invasion.[2,3] Patients with tumors greater than 7 mm in thickness are at increased risk for metastatic disease and melanoma-related death compared with patients with thinner tumors.
Standard treatment options:
There are several options for management of ciliary body melanoma. All of them are reported from case series.[Level of evidence: 3iiiDiv] The choice of therapy, however, depends on many factors.
- Plaque radiation therapy: Local control rates are high, but treatment is associated with a high incidence of secondary cataract.[4,5]
- External-beam, charged-particle radiation therapy: This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.[6-8]
- Local tumor resection: This option is mainly suitable for selected ciliary body or anterior choroidal tumors with smaller basal dimension and greater thickness.[9,10]
- Enucleation: This option is generally reserved for large melanomas when there is no hope of regaining useful vision. It is also indicated in the presence of intractable secondary glaucoma and extraocular extension.[5,8]
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with ciliary body and choroid melanoma, small size. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.References
- Nguyen QD, Foster CS: Ciliary body melanoma masquerading as chronic uveitis. Ocul Immunol Inflamm 6 (4): 253-6, 1998. [PUBMED Abstract]
- Marigo FA, Finger PT, McCormick SA, et al.: Iris and ciliary body melanomas: ultrasound biomicroscopy with histopathologic correlation. Arch Ophthalmol 118 (11): 1515-21, 2000. [PUBMED Abstract]
- Daftari I, Barash D, Lin S, et al.: Use of high-frequency ultrasound imaging to improve delineation of anterior uveal melanoma for proton irradiation. Phys Med Biol 46 (2): 579-90, 2001. [PUBMED Abstract]
- Gündüz K, Shields CL, Shields JA, et al.: Plaque radiotherapy of uveal melanoma with predominant ciliary body involvement. Arch Ophthalmol 117 (2): 170-7, 1999. [PUBMED Abstract]
- Finger PT: Plaque radiation therapy for malignant melanoma of the iris and ciliary body. Am J Ophthalmol 132 (3): 328-35, 2001. [PUBMED Abstract]
- Munzenrider JE: Uveal melanomas. Conservation treatment. Hematol Oncol Clin North Am 15 (2): 389-402, 2001. [PUBMED Abstract]
- Char DH, Kroll SM, Castro J: Ten-year follow-up of helium ion therapy for uveal melanoma. Am J Ophthalmol 125 (1): 81-9, 1998. [PUBMED Abstract]
- De Potter P: [Choroidal melanoma: current therapeutic approaches] J Fr Ophtalmol 25 (2): 203-11, 2002. [PUBMED Abstract]
- De Potter P, Shields CL, Shields JA: New treatment modalities for uveal melanoma. Curr Opin Ophthalmol 7 (3): 27-32, 1996. [PUBMED Abstract]
- Char DH, Miller T, Crawford JB: Uveal tumour resection. Br J Ophthalmol 85 (10): 1213-9, 2001. [PUBMED Abstract]