Skip to main content
SpringerLink
Log in

Diagnosis and Management of Small Choroidal Melanoma

  • Chapter
  • First Online:
Book cover Ocular Oncology

Part of the book series: Current Practices in Ophthalmology ((CUPROP))

  • 385 Accesses

Abstract

Uveal melanoma is the most common primary ocular cancer in adults. Key advancements have been made over the past decade in terms of molecularly classifying uveal melanoma and maximizing treatment outcomes of plaque brachytherapy. Also, various targeted immunotherapies are currently being investigated as adjuvant and metastatic treatments for uveal melanoma.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hu DN, Yu GP, McCormick SA, Schneider S, Finger PT. Population-based incidence of uveal melanoma in various races and ethnic groups. Am J Ophthalmol. 2005;140(4):612–7. https://doi.org/10.1016/j.ajo.2005.05.034.

    Article  PubMed  Google Scholar 

  2. Dogrusoz M, Jager MJ, Damato B. Uveal melanoma treatment and prognostication. Asia Pac J Ophthalmol. 2017;6(2):186–96. https://doi.org/10.22608/APO.201734.

    Article  Google Scholar 

  3. Collaborative Ocular Melanoma Study Group. Assessment of metastatic disease status at death in 435 patients with large choroidal melanoma in the Collaborative Ocular Melanoma Study (COMS): COMS report no. 15. Arch Ophthalmol. 2001;119(5):670–6.

    Article  Google Scholar 

  4. Diener-West M, Reynolds SM, Agugliaro DJ, Caldwell R, Cumming K, Earle JD, Hawkins BS, Hayman JA, Jaiyesimi I, Jampol LM, Kirkwood JM, Koh WJ, Robertson DM, Shaw JM, Straatsma BR, Thoma J, Collaborative Ocular Melanoma Study Group. Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group report no. 26. Arch Ophthalmol. 2005;123(12):1639–43. https://doi.org/10.1001/archopht.123.12.1639.

    Article  PubMed  Google Scholar 

  5. Diener-West M, Earle JD, Fine SL, Hawkins BS, Moy CS, Reynolds SM, Schachat AP, Straatsma BR, Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: initial mortality findings. COMS report no. 18. Arch Ophthalmol. 2001;119(7):969–82.

    Article  CAS  PubMed  Google Scholar 

  6. Kujala E, Makitie T, Kivela T. Very long-term prognosis of patients with malignant uveal melanoma. Invest Ophthalmol Vis Sci. 2003;44(11):4651–9.

    Article  PubMed  Google Scholar 

  7. Chew AL, Spilsbury K, Isaacs TW. Survival from uveal melanoma in Western Australia 1981-2005. Clin Exp Ophthalmol. 2015;43(5):422–8. https://doi.org/10.1111/ceo.12490.

    Article  PubMed  Google Scholar 

  8. Shields CL, Furuta M, Thangappan A, Nagori S, Mashayekhi A, Lally DR, Kelly CC, Rudich DS, Nagori AV, Wakade OA, Mehta S, Forte L, Long A, Dellacava EF, Kaplan B, Shields JA. Metastasis of uveal melanoma millimeter-by-millimeter in 8033 consecutive eyes. Arch Ophthalmol. 2009;127(8):989–98. https://doi.org/10.1001/archophthalmol.2009.208.

    Article  PubMed  Google Scholar 

  9. Costache M, Patrascu OM, Adrian D, Costache D, Sajin M, Ungureanu E, Simionescu O. Ciliary body melanoma—a particularly rare type of ocular tumor. Case report and general considerations. Maedica (Buchar). 2013;8(4):360–4.

    Google Scholar 

  10. Shields CL, Kaliki S, Furuta M, Mashayekhi A, Shields JA. Clinical spectrum and prognosis of uveal melanoma based on age at presentation in 8,033 cases. Retina. 2012;32(7):1363–72. https://doi.org/10.1097/IAE.0b013e31824d09a8.

    Article  PubMed  Google Scholar 

  11. Kaliki S, Shields CL, Mashayekhi A, Ganesh A, Furuta M, Shields JA. Influence of age on prognosis of young patients with uveal melanoma: a matched retrospective cohort study. Eur J Ophthalmol. 2013;23(2):208–16. https://doi.org/10.5301/ejo.5000200.

    Article  PubMed  Google Scholar 

  12. Onken MD, Worley LA, Ehlers JP, Harbour JW. Gene expression profiling in uveal melanoma reveals two molecular classes and predicts metastatic death. Cancer Res. 2004;64(20):7205–9. https://doi.org/10.1158/0008-5472.CAN-04-1750.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Field MG, Harbour JW. Recent developments in prognostic and predictive testing in uveal melanoma. Curr Opin Ophthalmol. 2014;25(3):234–9. https://doi.org/10.1097/ICU.0000000000000051.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shields CL, Kels JG, Shields JA. Melanoma of the eye: revealing hidden secrets, one at a time. Clin Dermatol. 2015;33(2):183–96. https://doi.org/10.1016/j.clindermatol.2014.10.010.

    Article  PubMed  Google Scholar 

  15. The Collaborative Ocular Melanoma Study Group. Factors predictive of growth and treatment of small choroidal melanoma: COMS report no. 5. Arch Ophthalmol. 1997;115(12):1537–44.

    Article  Google Scholar 

  16. Nguyen BT, Kim RS, Bretana ME, Kegley E, Schefler AC. Association between traditional clinical high-risk features and gene expression profile classification in uveal melanoma. Graefes Arch Clin Exp Ophthalmol. 2018;256(2):421–7. https://doi.org/10.1007/s00417-017-3856-x.

    Article  CAS  PubMed  Google Scholar 

  17. Kim RS, Chevez-Barrios P, Bretana ME, Wong TP, Teh BS, Schefler AC. Histopathologic analysis of transvitreal fine needle aspiration biopsy needle tracts for uveal melanoma. Am J Ophthalmol. 2017;174:9–16. https://doi.org/10.1016/j.ajo.2016.10.019.

    Article  PubMed  Google Scholar 

  18. Schefler AC, Gologorsky D, Marr BP, Shields CL, Zeolite I, Abramson DH. Extraocular extension of uveal melanoma after fine-needle aspiration, vitrectomy, and open biopsy. JAMA Ophthalmol. 2013;131(9):1220–4. https://doi.org/10.1001/jamaophthalmol.2013.2506.

    Article  PubMed  Google Scholar 

  19. Singh AD, Medina CA, Singh N, Aronow ME, Biscotti CV, Triozzi PL. Fine-needle aspiration biopsy of uveal melanoma: outcomes and complications. Br J Ophthalmol. 2016;100(4):456–62. https://doi.org/10.1136/bjophthalmol-2015-306921.

    Article  PubMed  Google Scholar 

  20. Shields CL, Ganguly A, Materin MA, Teixeira L, Mashayekhi A, Swanson LA, Marr BP, Shields JA. Chromosome 3 analysis of uveal melanoma using fine-needle aspiration biopsy at the time of plaque radiotherapy in 140 consecutive cases: the Deborah Iverson, MD, Lectureship. Arch Ophthalmol. 2007;125(8):1017–24. https://doi.org/10.1001/archopht.125.8.1017.

    Article  PubMed  Google Scholar 

  21. Correa ZM, Augsburger JJ. Sufficiency of FNAB aspirates of posterior uveal melanoma for cytologic versus GEP classification in 159 patients, and relative prognostic significance of these classifications. Graefes Arch Clin Exp Ophthalmol. 2014;252(1):131–5. https://doi.org/10.1007/s00417-013-2515-0.

    Article  CAS  PubMed  Google Scholar 

  22. Kim RS, Chevez-Barrios P, Divatia M, Bretana ME, Teh BS, Schefler AC. Transvitreal and transscleral biopsies in small uveal melanoma: report on yield, techniques, and complications. JAMA Ophthalmol. 2018;2(4):208–12.

    Google Scholar 

  23. Melia BM, Abramson DH, Albert DM, Boldt HC, Earle JD, Hanson WF, Montague P, Moy CS, Schachat AP, Simpson ER, Straatsma BR, Vine AK, Weingeist TA, Collaborative Ocular Melanoma Study Group. Collaborative ocular melanoma study (COMS) randomized trial of I-125 brachytherapy for medium choroidal melanoma. I. Visual acuity after 3 years COMS report no. 16. Ophthalmology. 2001;108(2):348–66.

    Article  CAS  PubMed  Google Scholar 

  24. American Brachytherapy Society–Ophthalmic Oncology Task Force. Electronic Address Pec, Committee AO. The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma. Brachytherapy. 2014;13(1):1–14. https://doi.org/10.1016/j.brachy.2013.11.008.

    Article  Google Scholar 

  25. Nag S, Quivey JM, Earle JD, Followill D, Fontanesi J, Finger PT, American Brachytherapy S. The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas. Int J Radiat Oncol Biol Phys. 2003;56(2):544–55.

    Article  PubMed  Google Scholar 

  26. Astrahan MA, Luxton G, Pu Q, Petrovich Z. Conformal episcleral plaque therapy. Int J Radiat Oncol Biol Phys. 1997;39(2):505–19.

    Article  CAS  PubMed  Google Scholar 

  27. King B, Morales-Tirado VM, Wynn HG, Gao BT, Ballo MT, Wilson MW. Repeat episcleral plaque brachytherapy: clinical outcomes in patients treated for locally recurrent posterior uveal melanoma. Am J Ophthalmol. 2017;176:40–5. https://doi.org/10.1016/j.ajo.2016.12.022.

    Article  PubMed  Google Scholar 

  28. Aziz HA, Al Zahrani YA, Bena J, Lorek B, Wilkinson A, Suh J, Singh AD. Episcleral brachytherapy of uveal melanoma: role of intraoperative echographic confirmation. Br J Ophthalmol. 2017;101(6):747–51. https://doi.org/10.1136/bjophthalmol-2016-309153.

    Article  PubMed  Google Scholar 

  29. Tabandeh H, Chaudhry NA, Murray TG, Ehlies F, Hughes R, Scott IU, Markoe AM. Intraoperative echographic localization of iodine-125 episcleral plaque for brachytherapy of choroidal melanoma. Am J Ophthalmol. 2000;129(2):199–204.

    Article  CAS  PubMed  Google Scholar 

  30. Mruthyunjaya P, Seider MI, Stinnett S, Schefler A, Ocular Oncology Study Consortium. Association between tumor regression rate and gene expression profile after iodine 125 plaque radiotherapy for uveal melanoma. Ophthalmology. 2017;124(10):1532–9. https://doi.org/10.1016/j.ophtha.2017.04.013.

    Article  PubMed  Google Scholar 

  31. Ophthalmic Oncology Task Force. Local recurrence significantly increases the risk of metastatic uveal melanoma. Ophthalmology. 2016;123(1):86–91. https://doi.org/10.1016/j.ophtha.2015.09.014.

    Article  Google Scholar 

  32. Force OOT. Local recurrence significantly increases the risk of metastatic uveal melanoma. Ophthalmology. 2016;123(1):86–91. https://doi.org/10.1016/j.ophtha.2015.09.014.

    Article  Google Scholar 

  33. Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol. 2006;124(12):1684–93. https://doi.org/10.1001/archopht.124.12.1684.

    Article  Google Scholar 

  34. Berry JL, Dandapani SV, Stevanovic M, Lee TC, Astrahan M, Murphree AL, Kim JW. Outcomes of choroidal melanomas treated with eye physics: a 20-year review. JAMA Ophthalmol. 2013;131(11):1435–42. https://doi.org/10.1001/jamaophthalmol.2013.4422.

    Article  PubMed  Google Scholar 

  35. Tann AW, Teh BS, Scarboro SB, Lewis GD, Bretana ME, Croft PC, Raizen Y, Butler EB, Kim RS, Chevez-Barrios P, Schefler AC. Early outcomes of uveal melanoma treated with intraoperative ultrasound guided brachytherapy using custom built plaques. Pract Radiat Oncol. 2017;7(4):e275–82. https://doi.org/10.1016/j.prro.2017.01.002.

    Article  PubMed  Google Scholar 

  36. McCannel TA, Chang MY, Burgess BL. Multi-year follow-up of fine-needle aspiration biopsy in choroidal melanoma. Ophthalmology. 2012;119(3):606–10. https://doi.org/10.1016/j.ophtha.2011.08.046.

    Article  PubMed  Google Scholar 

  37. Seibel I, Cordini D, Rehak M, Hager A, Riechardt AI, Boker A, Heufelder J, Weber A, Gollrad J, Besserer A, Joussen AM. Local recurrence after primary proton beam therapy in uveal melanoma: risk factors, retreatment approaches, and outcome. Am J Ophthalmol. 2015;160(4):628–36. https://doi.org/10.1016/j.ajo.2015.06.017.

    Article  PubMed  Google Scholar 

  38. Desjardins L, Lumbroso L, Levy C, Mazal A, Delacroix S, Rosenwald JC, Dendale R, Plancher C, Asselain B. Treatment of uveal melanoma with iodine 125 plaques or proton beam therapy: indications and comparison of local recurrence rates. J Fr Ophthalmol. 2003;26(3):269–76.

    CAS  Google Scholar 

  39. Pereira PR, Odashiro AN, Lim LA, Miyamoto C, Blanco PL, Odashiro M, Maloney S, De Souza DF, Burnier MN Jr. Current and emerging treatment options for uveal melanoma. Clin Ophthalmol. 2013;7:1669–82. https://doi.org/10.2147/OPTH.S28863.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Finger PT, Chin KJ, Semenova EA. Intravitreal anti-VEGF therapy for macular radiation retinopathy: a 10-year study. Eur J Ophthalmol. 2016;26(1):60–6. https://doi.org/10.5301/ejo.5000670.

    Article  PubMed  Google Scholar 

  41. Mashayekhi A, Rojanaporn D, Al-Dahmash S, Shields CL, Shields JA. Monthly intravitreal bevacizumab for macular edema after iodine-125 plaque radiotherapy of uveal melanoma. Eur J Ophthalmol. 2014;24(2):228–34. https://doi.org/10.5301/ejo.5000352.

    Article  PubMed  Google Scholar 

  42. Kim IK, Lane AM, Jain P, Awh C, Gragoudas ES. Ranibizumab for the prevention of radiation complications in patients treated with proton beam irradiation for choroidal melanoma. Trans Am Ophthalmol Soc. 2016;114:T2.

    PubMed  PubMed Central  Google Scholar 

  43. Komatsubara KM, Carvajal RD. Immunotherapy for the treatment of uveal melanoma: current status and emerging therapies. Curr Oncol Rep. 2017;19(7):45. https://doi.org/10.1007/s11912-017-0606-5.

    Article  CAS  PubMed  Google Scholar 

  44. Triozzi PL, Singh AD. Adjuvant therapy of uveal melanoma: current status. Ocul Oncol Pathol. 2014;1(1):54–62. https://doi.org/10.1159/000367715.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lane AM, Egan KM, Harmon D, Holbrook A, Munzenrider JE, Gragoudas ES. Adjuvant interferon therapy for patients with uveal melanoma at high risk of metastasis. Ophthalmology. 2009;116(11):2206–12. https://doi.org/10.1016/j.ophtha.2009.04.044.

    Article  PubMed  Google Scholar 

  46. Jager MJ, Dogrusoz M, Woodman SE. Uveal melanoma: identifying immunological and chemotherapeutic targets to treat metastases. Asia Pac J Ophthalmol. 2017;6(2):179–85. https://doi.org/10.22608/APO.201782.

    Article  CAS  Google Scholar 

  47. Luke JJ, Callahan MK, Postow MA, Romano E, Ramaiya N, Bluth M, Giobbie-Hurder A, Lawrence DP, Ibrahim N, Ott PA, Flaherty KT, Sullivan RJ, Harding JJ, D’Angelo S, Dickson M, Schwartz GK, Chapman PB, Wolchok JD, Hodi FS, Carvajal RD. Clinical activity of ipilimumab for metastatic uveal melanoma: a retrospective review of the Dana-Farber Cancer Institute, Massachusetts General Hospital, Memorial Sloan-Kettering Cancer Center, and University Hospital of Lausanne experience. Cancer. 2013;119(20):3687–95. https://doi.org/10.1002/cncr.28282.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Algazi AP, Tsai KK, Shoushtari AN, Munhoz RR, Eroglu Z, Piulats JM, Ott PA, Johnson DB, Hwang J, Daud AI, Sosman JA, Carvajal RD, Chmielowski B, Postow MA, Weber JS, Sullivan RJ. Clinical outcomes in metastatic uveal melanoma treated with PD-1 and PD-L1 antibodies. Cancer. 2016;122(21):3344–53. https://doi.org/10.1002/cncr.30258.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Field MG, Decatur CL, Kurtenbach S, Gezgin G, van der Velden PA, Jager MJ, Kozak KN, Harbour JW. PRAME as an independent biomarker for metastasis in uveal melanoma. Clin Cancer Res. 2016;22(5):1234–42. https://doi.org/10.1158/1078-0432.CCR-15-2071.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Gezgin G, Luk SJ, Cao J, Dogrusoz M, van der Steen DM, Hagedoorn RS, Krijgsman D, van der Velden PA, Field MG, Luyten GPM, Szuhai K, Harbour JW, Jordanova ES, Heemskerk MHM, Jager MJ. PRAME as a potential target for immunotherapy in metastatic uveal melanoma. JAMA Ophthalmol. 2017;135(6):541–9. https://doi.org/10.1001/jamaophthalmol.2017.0729.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kines RC, Varsavsky I, Choudhary S, Bhattacharya D, Spring S, McLaughlin RJ, Kang SJ, Grossniklaus HE, Vavvas DG, Monks S, MacDougall JR, de Los Pinos E, Schiller JT. An infrared dye-conjugated virus-like particle for the treatment of primary uveal melanoma. Mol Cancer Ther. 2018;17(2):565–74. https://doi.org/10.1158/1535-7163.MCT-17-0953.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA

    Amy C. Schefler

  2. Children’s Memorial Hermann Hospital, University of Texas Health Sciences, San Antonio, TX, USA

    Amy C. Schefler & Ryan Sangwoo Kim

Authors
  1. Amy C. Schefler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan Sangwoo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy C. Schefler .

Editor information

Editors and Affiliations

  1. University of Louisville, Louisville, KY, USA

    Aparna Ramasubramanian

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Schefler, A.C., Kim, R.S. (2019). Diagnosis and Management of Small Choroidal Melanoma. In: Ramasubramanian, A. (eds) Ocular Oncology . Current Practices in Ophthalmology. Springer, Singapore. https://doi.org/10.1007/978-981-13-7538-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-981-13-7538-5_2

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-7537-8

  • Online ISBN: 978-981-13-7538-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation