Melanoma can affect the uveal tract; its most frequent location is the choroid. Often the patient presents having attended the optician for a routine visit and a pigmented lesion has been noted. The patient may present with visual loss. Biopsies should not be performed. Diagnosis should be made by an ophthalmologist with experience in this field. Management should ideally be carried out in a combined ophthalmic-oncology clinic.

Treatment may be observation, radioactive eye plaque (ruthenium or iodine), local resection, charged particles (proton beam), or enucleation. A small lesion may represent a naevus so it is important to document growth. This is carried out by three-monthly examinations with indirect ophthalmoscopy and serial photographs. An increase in size of 1 mm is significant.

Treatment with Ruthenium 106 radioactive eye plaques causes less morbidity than iodine 125 plaques but can only treat tumours up to a maximum depth of 5 mm. Iodine plaques omit low-energy gamma-rays, so that tumours up to 8 mm depth can be treated. A dose of 80-100 Gy is given to the apex of the tumour, or 500 Gy to the base. Local resection and proton-beam irradiation are used for larger tumours.

Results after local resection have been shown to be better if a radioactive eye plaque is inserted at the end of the operation to irradiate the tumour bed. Proton-beam irradiation showed great promise but the treatment is expensive, time-consuming, and can be only used for very selected cases. The prognosis depends on the location of the tumour, tumour dimensions, and histology. Tumours with spindle B-cell elements do better than mixed epithelioid and spindle B tumours.

How To Prevent Skin Cancer

How To Prevent Skin Cancer

Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.

Get My Free Ebook

Post a comment