Ординатура / Офтальмология / Английские материалы / Current Concepts in Uveal Melanoma_Desjardins, Kivela, Damato_2011

Current Concepts in Uveal Melanoma

Developments in Ophthalmology

Vol. 49

Series Editor

F. Bandello Milan

Current Concepts in

Uveal Melanoma

Volume Editors

Martine J. Jager Leiden

Laurence Desjardins Paris

Tero Kivelä Helsinki

Bertil E. Damato Liverpool

37 figures, 23 in color, and 12 tables, 2012

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Library of Congress Cataloging-in-Publication Data

Current concepts in uveal melanoma / volume editors, Martine J. Jager ...

[et al.].

p. ; cm. -- (Developments in ophthalmology, ISSN 0250-3751 ; v. 49) Includes bibliographical references and index.

ISBN 978-3-8055-9790-6 (hard cover : alk. paper) -- ISBN 978-3-8055-9791-3 (e-ISBN)

I. Jager, Martine. II. Series: Developments in ophthalmology ; v. 49. 0250-3751

[DNLM: 1. Melanoma--therapy. 2. Uveal Neoplasms--therapy. 3. Melanoma--diagnosis. 4. Uveal Neoplasms--diagnosis. W1 DE998NG v.49 2012 / WW 240]

616.99'477--dc23

2011033492

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© Copyright 2012 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) www.karger.com

Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISSN 0250–3751

ISBN 978–3–8055–9790–6 e-ISBN 978–3–8055–9791–3

Jager MJ, Desjardins L, Kivelä T, Damato BE (eds): Current Concepts in Uveal Melanoma. Dev Ophthalmol. Basel, Karger, 2012, vol 49, pp 1–15

Diagnosis of Uveal Melanoma

Tero Kivelä

Ocular Oncology Service, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland

Abstract

The diagnosis of uveal melanoma is based on clinical examination with the slit lamp and indirect ophthalmoscope together with ultrasonography of the eye. Large to medium-sized melanomas are reliably diagnosed using these methods. The challenge lies in early detection. Small melanomas are more difficult to tell from presumed naevi. A useful mnemonic ‘to find small ocular melanomas’ reminds the general ophthalmologist to look for tumour thickness of more than 2 mm, subretinal fluid, visual symptoms, orange pigment and location of the tumour margin at the optic disc. Optical coherence tomography and fundus autofluorescence imaging help in identifying subretinal fluid and orange pigment and in measuring the thickness of thin choroidal tumours. Each of the risk characteristics roughly doubles the likelihood of growth so that the risk for growth is about 30 times higher when all five characteristics are present as compared to their absence. In addition, a low acoustic profile, the absence of a halo around the tumour and the absence of drusen over it increase the likelihood of growth. Patients with a choroidal melanocytic tumour with at least one risk characteristic benefit from referral to an ocular oncologist. We recommend that the rest of the patients be made aware of their presumed naevus and that they should be observed periodically. The patients should also be told to return immediately if they develop new visual symptoms. Finally, the trend is toward taking a biopsy of suspicious small choroidal tumours as an alternative to documenting growth before treating them as melanomas.

The diagnosis of uveal melanoma is based on clinical examination with the slit lamp and indirect ophthalmoscope together with ultrasonography of the eye. Iris melanomas are readily observable, whereas ciliary body melanomas are difficult to detect when small because they are hidden behind the iris. Choroidal melanomas can also be missed unless the fundus is meticulously examined after full pupillary dilatation. Digital photography is most useful for documenting their size and location. When a choroidal tumour is large or peripheral, wide-angle cameras are especially helpful (fig. 1a–d).

Smaller choroidal melanomas are flat to dome in shape (fig. 1a). Exudative retinal detachment develops early (fig. 1b) and may eventually hide the tumour. With time tumours break through Bruch’s membrane and acquire an essentially pathognomonic