Small Choroidal Melanoma
A wide range of 5-year mortality rates have been reported among patients treated for small choroidal melanomas, with an average rate of about 16%.[1,2] Several studies indicate that the two most important clinical factors predictive of mortality are larger tumor size (at the time of treatment) and documentation of tumor growth.
The management of small choroidal melanomas is controversial. The likelihood of progression from the time of diagnosis to growth warranting treatment has not been well characterized. Many ophthalmologists advocate initial observation. This initial management strategy is justified on several grounds, including the difficulty in establishing a correct diagnosis, the lack of any documented efficacy for globe-conserving treatments, and concerns for severe treatment-related morbidity. Others have advocated earlier therapeutic intervention.[4-6]
Standard treatment options:
- Observation: This strategy is important for patients with an uncertain diagnosis or in whom tumor growth has not been documented. It is also used for asymptomatic patients with stable lesions (particularly elderly or debilitated patients), and patients with a tumor in their only useful eye.
- Plaque radiation therapy: This treatment is used for small- or medium-sized uveal melanomas, amelanotic tumors, or tumors that touch the optic disc for greater than 3 clock-hours of optic disk circumference.[7,8]
- External-beam, charged-particle radiation therapy: This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.[7-10]
- Gamma-knife radiation surgery: This treatment may be a feasible option for small-sized to medium-sized melanomas.[11-13]
- Transpupillary thermotherapy: As noted above, this approach has very limited use, but it can be used as a primary treatment or as an adjunctive method to plaque radiation therapy.[5,6,14-18] (Refer to the Role of Transpupillary Thermotherapy section in the Treatment Option Overview section of this summary for more information.)
- Local tumor resection: This strategy is used mainly for selected ciliary body or anterior choroidal tumors with smaller basal dimensions and greater thickness.
- Enucleation: This approach is used when severe intraocular pressure elevation is a factor. It may also be considered with small- and medium-sized melanomas that are invading the tissues of the optic nerve.
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
- Diener-West M, Hawkins BS, Markowitz JA, et al.: A review of mortality from choroidal melanoma. II. A meta-analysis of 5-year mortality rates following enucleation, 1966 through 1988. Arch Ophthalmol 110 (2): 245-50, 1992. [PUBMED Abstract]
- Mortality in patients with small choroidal melanoma. COMS report no. 4. The Collaborative Ocular Melanoma Study Group. Arch Ophthalmol 115 (7): 886-93, 1997. [PUBMED Abstract]
- Shields CL, Shields JA, Kiratli H, et al.: Risk factors for growth and metastasis of small choroidal melanocytic lesions. Ophthalmology 102 (9): 1351-61, 1995. [PUBMED Abstract]
- Shields CL, Cater J, Shields JA, et al.: Combination of clinical factors predictive of growth of small choroidal melanocytic tumors. Arch Ophthalmol 118 (3): 360-4, 2000. [PUBMED Abstract]
- Shields CL, Shields JA, Perez N, et al.: Primary transpupillary thermotherapy for small choroidal melanoma in 256 consecutive cases: outcomes and limitations. Ophthalmology 109 (2): 225-34, 2002. [PUBMED Abstract]
- Robertson DM, Buettner H, Bennett SR: Transpupillary thermotherapy as primary treatment for small choroidal melanomas. Arch Ophthalmol 117 (11): 1512-9, 1999. [PUBMED Abstract]
- Shields CL, Shields JA, Gündüz K, et al.: Radiation therapy for uveal malignant melanoma. Ophthalmic Surg Lasers 29 (5): 397-409, 1998. [PUBMED Abstract]
- Finger PT: Radiation therapy for choroidal melanoma. Surv Ophthalmol 42 (3): 215-32, 1997 Nov-Dec. [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]
- Woodburn R, Danis R, Timmerman R, et al.: Preliminary experience in the treatment of choroidal melanoma with gamma knife radiosurgery. J Neurosurg 93 (Suppl 3): 177-9, 2000. [PUBMED Abstract]
- Modorati G, Miserocchi E, Galli L, et al.: Gamma knife radiosurgery for uveal melanoma: 12 years of experience. Br J Ophthalmol 93 (1): 40-4, 2009. [PUBMED Abstract]
- Muller K, Nowak PJ, de Pan C, et al.: Effectiveness of fractionated stereotactic radiotherapy for uveal melanoma. Int J Radiat Oncol Biol Phys 63 (1): 116-22, 2005. [PUBMED Abstract]
- Shields CL, Shields JA: Transpupillary thermotherapy for choroidal melanoma. Curr Opin Ophthalmol 10 (3): 197-203, 1999. [PUBMED Abstract]
- Godfrey DG, Waldron RG, Capone A Jr: Transpupillary thermotherapy for small choroidal melanoma. Am J Ophthalmol 128 (1): 88-93, 1999. [PUBMED Abstract]
- Bartlema YM, Oosterhuis JA, Journée-De Korver JG, et al.: Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience. Br J Ophthalmol 87 (11): 1370-3, 2003. [PUBMED Abstract]
- Harbour JW, Meredith TA, Thompson PA, et al.: Transpupillary thermotherapy versus plaque radiotherapy for suspected choroidal melanomas. Ophthalmology 110 (11): 2207-14; discussion 2215, 2003. [PUBMED Abstract]
- Pilotto E, Vujosevic S, De Belvis V, et al.: Long-term choroidal vascular changes after iodine brachytherapy versus transpupillary thermotherapy for choroidal melanoma. Eur J Ophthalmol 19 (4): 646-53, 2009 Jul-Aug. [PUBMED Abstract]
- Char DH, Miller T, Crawford JB: Uveal tumour resection. Br J Ophthalmol 85 (10): 1213-9, 2001. [PUBMED Abstract]
- Shields JA, Shields CL: Atlas of Intraocular Tumors. Philadelphia, Pa: Lippincott Williams & Wilkins, 1999.