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NCI CANCERLIT^® Search: Intraocular Melanoma - July 2002

National Cancer Institute^®
Last Modified: July 1, 2002

Management of posterior uveal melanoma: past, present, future.
Clinical features of small choroidal melanoma.
Cadherin expression in uveal melanoma.
Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: tumor control and treatment complications in 270
[Choroidal nevi associated with serous macular detachment]

Table of Contents

1
UI - 11927844
AU - Shields JA
TI - Management of posterior uveal melanoma: past, present, future.
SO - Retina 2002 Apr;22(2):139-42

2
UI - 12011680
AU - Shields CL; Shields JA
TI - Clinical features of small choroidal melanoma.
SO - Curr Opin Ophthalmol 2002 Jun;13(3):135-41
AD - Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. carol.shields@shieldsoncology.com
The detection and treatment of choroidal melanoma early in its natural course is critical to providing the patient with the best prognosis. Patients with small choroidal melanoma (< 4 mm thickness) develop metastasis in 16% of cases at 5 years follow up, whereas those with medium choroidal melanoma (4-8 mm thickness) and large choroidal melanoma (> 8 mm thickness) develop metastasis in 32 and 53%, respectively. The difficulty with early detection of choroidal melanoma relates to its clinical similarity to benign choroidal nevus. Factors that differentiate small choroidal melanoma from choroidal nevus can be remembered using the mnemonic TFSOM, indicating To Find Small Ocular Melanoma. The letters in this mnemonic represent T (Thickness >2 mm), F (subretinal Fluid), S (Symptoms), O (Orange pigment), and M (Margin touching optic disc). Choroidal melanocytic tumors that display 0 factors have 3% chance for growth at 5 years and most likely represent choroidal nevi. Tumors that display one factor have a 38% chance for growth and those with two or more factors show growth in over 50% of cases at 5 years. Most of those tumors with two or more risk factors probably represent small choroidal melanoma and early treatment is generally indicated. Therefore, ophthalmologists should be aware of the important factors that identify small choroidal melanoma so that early treatment and better life prognosis can be achieved for their patients.

3
UI - 12014924
AU - Anastassiou G; Tschentscher F; Zeschnigk M; Bornfeld N
TI - Cadherin expression in uveal melanoma.
SO - Exp Eye Res 2002 Mar;74(3):423-5

4
UI - 12096964
AU - Shields CL; Cater J; Shields JA; Chao A; Krema H; Materin M; Brady LW
TI - Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: tumor control and treatment complications in 270 consecutive patients.
SO - Arch Ophthalmol 2002 Jul;120(7):933-40
AD - Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut St, Philadelphia, PA 19107, USA. carol.shields@shieldsoncology.com
OBJECTIVE: To evaluate tumor control and treatment complications following plaque radiotherapy combined with transpupillary thermotherapy for choroidal melanoma. DESIGN: Prospective noncomparative interventional case series. INTERVENTION: All patients received treatment for choroidal melanoma using plaque radiotherapy followed by 3 sessions of transpupillary thermotherapy provided at plaque removal and at 4-month intervals. PARTICIPANTS: Two hundred seventy patients with newly diagnosed choroidal melanoma. MAIN OUTCOME MEASURES: The 2 main outcome measures included local tumor recurrence and treatment-related complications. The clinical data regarding patient features, tumor features, radiotherapy and thermotherapy parameters were analyzed for their effect on the 2 main outcomes using Cox proportional hazards regression models. RESULTS: Prior to treatment, the median base of the tumor was 11 mm (range, 4-21 mm) and the median thickness was 4 mm (range, 2-9 mm). Most tumors were located in the posterior pole with a median proximity of 2 mm to the foveola and 2 mm to the optic disc. The median radiotherapy dose to the tumor apex was 9000 rad. Transpupillary thermotherapy was applied in 3 sessions at 4-month intervals for a median of 700 mW. The tumor decreased in thickness to a median of 2.3 mm by 1 year and 2.1 mm by 2 years' follow-up with stable findings thereafter. Using Kaplan-Meier estimates, tumor recurrence was 2% at 2 years and 3% at 5 years. Risk factors for tumor recurrence included macular location of the tumor epicenter (P =.03), diffuse tumor configuration (P =.005), and tumor margin extending underneath the foveola (P =.001). Using Kaplan-Meier estimates, treatment-related complications at 5 years included maculopathy in 18% of the participants, papillopathy in 38%, macular retinal vascular obstruction in 18%, vitreous hemorrhage in 18%, rhegmatogenous retinal detachment in 2%, cataract in 6%, and neovascular glaucoma in 7%. Enucleation for radiation complications was necessary in 3 cases (1%). CONCLUSION: Plaque radiotherapy combined with transpupillary thermotherapy provides excellent local tumor control with only 3% recurrence at 5 years' follow-up.

5
UI - 12011744
AU - Duquesne N; Hajji Z; Jean-Louis B; Grange JD
TI - [Choroidal nevi associated with serous macular detachment]
SO - J Fr Ophtalmol 2002 Apr;25(4):393-8
AD - Clinique Ophtalmologique Universitaire B, UFR Lyon-Nord, Hopital de la Croix-Rousse, 93, Grande-rue de la Croix-Rousse, F-69317 Lyon Cedex 04, France.
PURPOSE: To describe the aspect and progression of choroidal nevi associated with macular serous detachment and to analyze different treatments. MATERIAL: and methods: Twelve posterior choroidal nevi were associated with subretinal fluid. The fovea was detached in 11 cases. Tumor thickness was 2 mm or less. RESULTS: No treatment was given in 6 cases and spontaneous subretinal fluid regression was observed in 3 of these 6 cases. Success was also observed in 2 of 3 cases treated with corticotherapy, but subretinal fluid recurred. Gas injection was performed in 1 case and transpupillary thermotherapy in 2 others, all 3 with successful definitive drying of the nevus. Visual acuity decreased in 6 cases (in 3 untreated cases and in 3 cases treated with corticotherapy), remained stable in 3 cases, and increased in 3 cases (in 1 untreated case, in 1 gas injection case, and in 1 case after thermotherapy). Tumor growth was observed in 3 cases, on the average 2 years after diagnosis (25%). CONCLUSION: Subretinal fluid is rarely observed with choroidal nevi and its progression is variable. Various treatments in addition to observation such as corticotherapy, gas injection, transpupillary thermotherapy seem effective in stabilizing or improving visual function. Supervision is nevertheless needed to detect tumor growth that can be frequent in these nevi associated with subretinal fluid.

The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.

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