eMedicine Specialties > Ophthalmology > Choroid

Melanoma, Choroidal: Treatment & Medication

Author: Enrique Garcia-Valenzuela, MD, PhD, Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center
Coauthor(s): Mauricio E Pons, MD, Associate Physician, Charles A Garcia, MD, PA; James E Puklin, MD, Professor, Department of Ophthalmology, Vitreoretinal Service, Kresge Eye Institute, Wayne State University; Cathleen A Davidson, MSc, Consulting Staff, Department of Obstetrics and Gynecology, Laboratory of Assisted Reproductive Technologies, University of Michigan
Contributor Information and Disclosures

Updated: Jun 24, 2009

Treatment

Medical Care

Several modes of treatment are available for choroidal melanomas. Multiple factors are taken into account when deciding one approach over other approaches, such as visual acuity of the affected eye, visual acuity of the contralateral eye, size of the tumor, age and general health of the patient, ocular structures involved, and presence of metastases.
  • Observation may be acceptable for posterior uveal tumors where diagnosis is not well established. In particular, tumors of less than 2-2.5 mm in elevation and 10 mm in diameter can be observed until growth is documented.
  • Photography and sequential ultrasonography for precise measuring of the tumor's dimensions is usually necessary.

Surgical Care

  • Enucleation is the classic approach to choroidal melanomas and has been the preferred treatment for large (basal diameter >15 mm and height >10 mm) and complicated tumors, which compromise visual function, and where other therapies tend to fail.
    • Because of potential release of malignant cells into the bloodstream and orbital soft tissues during the surgical procedure, manipulation of the globe should be kept to a minimum.
    • Particular care has to be taken to avoid perforation of the globe during surgery. If transscleral extension is found, the tumor should be removed in one piece, followed by cryotherapy of the involved orbital soft tissues.
    • The theoretical advantage of enucleation over globe-sparing treatments is a reduced risk of metastatic spread. However, the Collaborative Ocular Melanoma Study (COMS), where medium-sized tumors were treated with either iodine 125 brachytherapy or enucleation, found that the mortality rates following brachytherapy did not differ from the mortality rates following enucleation for up to 12 years after treatment. Some investigators have advocated pre-enucleation radiation of the eye as a way to improve survival. However, the Collaborative Ocular Melanoma Study (COMS) demonstrated neither a positive effect nor a negative effect on the 10-year mortality rates among patients whose eyes containing large choroidal melanomas were randomized to treatment with enucleation alone or enucleation preceded by external radiation.
  • Plaque brachytherapy is a widely accepted alternative to enucleation for medium-sized posterior uveal melanomas (<10 mm in height and <15 mm in diameter).
    • Plaques containing various radioactive isotopes, such as iridium, cobalt, ruthenium, and other isotopes, have been used. The most common material used in modern plaques is iodine 125, because of its lower energy emission (lack of alpha and beta rays), its good tissue penetration, and its commercial availability. Radiation from this source causes tumor destruction through damage of DNA in cancerous cells and tumor vessels, with consequent tumor necrosis and regression. However, it is not devoid of complications. Detorakis et al found that after iodine 125 brachytherapy for choroidal melanoma, iris and anterior chamber angle neovascularization developed in 23% of eyes.2
    • A computerized calculation is used to determine the dose and the duration of plaque application for a radiation delivery of approximately 400 Gy to the base and 80-100 Gy to the apex of the tumor, at 50-125 cGy/h.
    • The basal size of the melanoma is estimated preoperatively and confirmed during surgery. Appropriately sized plaques are sutured temporarily to the sclera and limbus underlying the melanoma. A margin of 2 mm over the largest tumor basal dimension is adequate. Intraoperative techniques, such as transillumination or ultrasound, are used to ensure proper plaque placement under the tumor.
    • Postoperative imaging confirmation of correct plaque localization is required. Radioactive plaques are left in place for 3-7 days. The goal of successful treatment is to achieve arrest of tumor growth or regression in size.
    • Local recurrence, usually requiring enucleation, occurs at a rate of about 12-16%. Plaque brachytherapy can cause complications, including cataract, rubeosis, scleral necrosis, keratopathy, radiation retinopathy, and optic neuropathy, but at a reduced rate compared with external beam irradiation.
  • External beam irradiation using charged particles, either protons or helium ions, is a frequently used alternative method to treat medium-sized choroidal melanomas (<10 mm in height and <15 mm in diameter), although it has been used for larger tumors. It has similar indications and success rates to plaque brachytherapy.
    • After conjunctival incision and localization of the melanoma with transillumination, radiopaque tantalum rings usually are sutured to the sclera to serve as reference markers for alignment of the radiation beam. A collimated beam delivers about 70 Gy, usually divided into 5 sessions.
    • Vital ocular structures are avoided through careful positioning of the head and eye. Irradiation causes damage of DNA in cancerous cells and tumor vessels, in a similar way to plaque brachytherapy, with consequent tumor necrosis and regression. Treatment may be complicated with exudative retinal detachment, radiation cataract, dry eye syndrome, epithelial keratopathy, rubeosis, radiation retinopathy, and optic neuropathy.
    • Patients treated with this method seem to have a survival rate comparable to those treated by enucleation. Treatment is successful when it achieves arrest of tumor growth or regression in size. About 10-15% of eyes ultimately require enucleation, often because of neovascular glaucoma or local recurrence.
  • Block excision, or sclerouvectomy, is an alternative treatment method for choroidal melanomas. It is reserved for small tumors covering less than a one third of the globe's circumference.
    • The goal of block excision is to salvage the eye, with most of these patients retaining some useful vision. It consists of full-thickness excision with in-block removal of tumor, choroid, retina, and sclera.
    • A 3-mm margin of healthy tissue around the melanoma is included, followed by closure with a graft of banked sclera. Surround treatment with cryotherapy or laser usually is added.
    • The most common complications are vitreous hemorrhage, retinal detachment, residual tumor, and cataract. Risks are improved by a modified approach, lamellar sclerouvectomy, which uses a partial-thickness scleral flap and minimizes altering the retina and vitreous. In a percentage of cases (about 15-20%), local reappearance of the melanoma requires subsequent treatment, usually enucleation.
  • Laser photocoagulation and transpupillary thermotherapy are used in selected small choroidal melanomas, when they are located away from the fovea and are less than 3 mm in thickness.
  • Orbital exenteration is a radical treatment reserved for cases with widespread orbital extension. Patients with such advanced melanomas are likely to have extensive distant metastases and poor prognosis for survival, with or without orbital exenteration surgery. The usefulness of such disfiguring surgery is not established and should only be considered in rare cases where marked discomfort is associated with massive orbital spread of the melanoma.
  • Choice of treatment of choroidal melanoma remains controversial in many respects. Although enucleation has been the treatment of choice in the past, it appears that vision-sparing approaches might offer similar degrees of ocular and metastatic tumor control. Particularly, because it is clear that, in many patients at the time of diagnosis, posterior uveal melanomas already have spread through micrometastasis.
  • A multicenter randomized trial conducted by the Collaborative Ocular Melanoma Study (COMS) Group regarding conservative management revealed that patient survival after treatment of medium-sized melanoma is similar when comparing plaque radiotherapy versus enucleation.
  • Although undetected metastatic spread at the time of diagnosis and treatment of choroidal melanoma is a major concern in every patient, adjuvant systemic treatment is not advocated. This consensus comes from treatment trials with intraocular melanomas and extrapolation of the experience with cutaneous melanoma, where adjuvant treatment has shown no benefit.
  • In cases where distant metastases are found during the initial systemic workup, treatment of the intraocular melanomas becomes palliative. Systemic chemotherapy is the primary treatment.
  • Many modalities and combinations of chemotherapeutic and immunotherapeutic agents exist, but, for the most part, results continue to be disappointing. This is an area of intense medical research with ever-increasing degrees of biological sophistication being applied to new clinical trials.

Consultations

  • Oncology
  • Radiation oncology

More on Melanoma, Choroidal

Overview: Melanoma, Choroidal
Differential Diagnoses & Workup: Melanoma, Choroidal
Treatment & Medication: Melanoma, Choroidal
Follow-up: Melanoma, Choroidal
Multimedia: Melanoma, Choroidal
References
[ CLOSE WINDOW ]

References

  1. Prescher G, Bornfeld N, Hirche H, et al. Prognostic implications of monosomy 3 in uveal melanoma. Lancet. May 4 1996;347(9010):1222-5. [Medline].

  2. Detorakis ET, Engstrom RE Jr, Wallace R, et al. Iris and anterior chamber angle neovascularization after iodine 125 brachytherapy for uveal melanoma. Ophthalmology. Mar 2005;112(3):505-10. [Medline].

  3. Accuracy of diagnosis of choroidal melanomas in the Collaborative Ocular Melanoma Study. COMS report no. 1. Arch Ophthalmol. Sep 1990;108(9):1268-73. [Medline].

  4. Augsburger JJ, Correa ZM, Freire J, et al. Long-term survival in choroidal and ciliary body melanoma after enucleation versus plaque radiation therapy. Ophthalmology. Sep 1998;105(9):1670-8. [Medline].

  5. Augsburger JJ, Gamel JW, Sardi VF, et al. Enucleation vs cobalt plaque radiotherapy for malignant melanomas of the choroid and ciliary body. Arch Ophthalmol. May 1986;104(5):655-61. [Medline].

  6. Augsburger JJ, Peyster RG, Markoe AM, et al. Computed tomography of posterior uveal melanomas. Arch Ophthalmol. Nov 1987;105(11):1512-6. [Medline].

  7. Cham MC, Pavlin CJ. Ultrasound detection of posterior scleral bowing in young patients with choroidal melanoma. Can J Ophthalmol. Aug 2000;35(5):263-6. [Medline].

  8. Chang M, Shields JA, Wachtel DL. Adenoma of the pigment epithelium of the ciliary body simulating a malignant melanoma. Am J Ophthalmol. Jul 1979;88(1):40-4. [Medline].

  9. Char DH, Kroll S, Quivey JM, et al. Long term visual outcome of radiated uveal melanomas in eyes eligible for randomisation to enucleation versus brachytherapy. Br J Ophthalmol. Feb 1996;80(2):117-24. [Medline].

  10. Char DH, Kroll SM, Miller T, et al. Irradiated uveal melanomas: cytopathologic correlation with prognosis. Am J Ophthalmol. Oct 1996;122(4):509-13. [Medline].

  11. Collaborative Ocular Melanoma Study. The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre- enucleation radiation of large choroidal melanoma III: local complications and observations following enucleation COMS report no. 11. Am J Ophthalmol. Sep 1998;126(3):362-72. [Medline].

  12. Collaborative Ocular Melanoma Study. The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma II: initial mortality findings. COMS report no. 10. Am J Ophthalmol. Jun 1998;125(6):779-96. [Medline].

  13. Collaborative Ocular Melanoma Study Group. Factors predictive of growth and treatment of small choroidal melanoma: COMS Report No. 5. The Collaborative Ocular Melanoma Study Group. Arch Ophthalmol. Dec 1997;115(12):1537-44. [Medline].

  14. Collaborative Ocular Melanoma Study Group. Mortality in patients with small choroidal melanoma. COMS report no. 4. The Collaborative Ocular Melanoma Study Group. Arch Ophthalmol. Jul 1997;115(7):886-93. [Medline].

  15. Collaborative Ocular Melanoma Study Group. Ten-year follow-up of fellow eyes of patients enrolled in Collaborative Ocular Melanoma Study randomized trials: COMS report no. 22. Ophthalmology. May 2004;111(5):966-76. [Medline].

  16. Collaborative Ocular Melanoma Study Group report no 4. Mortality in patients with small choroidal melanoma. The Collaborative Ocular Melanoma Study Group. Arch Ophthalmol. Jul 1997;115(7):886-93. [Medline].

  17. Collaborative Ocular Melanoma Study report no 10. The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre- enucleation radiation of large choroidal melanoma II: initial mortality findings. COMS report no. 10. Am J Ophthalmol. Jun 1998;125(6):779-96. [Medline].

  18. Collaborative Ocular Melanoma Study report no 6. Histopathologic characteristics of uveal melanomas in eyes enucleated from the Collaborative Ocular Melanoma Study. Am J Ophthalmol. Jun 1998;125(6):745-66. [Medline].

  19. Corrêa ZM, Augsburger JJ, Freire J, et al. Early-onset scleral necrosis after iodine I 125 plaque radiotherapy for ciliochoroidal melanoma. Arch Ophthalmol. Feb 1999;117(2):259-61. [Medline].

  20. Daubert GL, Puklin. Intraoperative use of ultrasound to document proper plaque placement in treating choroidal melanoma. Ultrasonography in Ophthalmology. 1990;12:351-5.

  21. Daubert GL, Puklin JE. Echographic patterns simulating extrascleral extension of malignant melanoma following plaque removal. Ultrasonography in Ophthalmology. 1990;12:345-9.

  22. De Potter P, Shields CL, Shields JA, et al. Plaque radiotherapy for juxtapapillary choroidal melanoma. Visual acuity and survival outcome. Arch Ophthalmol. Nov 1996;114(11):1357-65. [Medline].

  23. Dithmar S, Diaz CE, Grossniklaus HE. Intraocular melanoma spread to regional lymph nodes: report of two cases. Retina. 2000;20(1):76-9. [Medline].

  24. Dithmar S, Völcker HE, Grossniklaus HE. Multifocal intraocular malignant melanoma: report of two cases and review of the literature. Ophthalmology. Jul 1999;106(7):1345-8. [Medline].

  25. Donoso LA, Shields JA, Augsburger JJ, et al. Antigenic and cellular heterogeneity of primary uveal malignant melanomas. Arch Ophthalmol. Jan 1986;104(1):106-10. [Medline].

  26. Egan KM, Ryan LM, Gragoudas ES. Survival implications of enucleation after definitive radiotherapy for choroidal melanoma: an example of regression on time-dependent covariates. Arch Ophthalmol. Mar 1998;116(3):366-70. [Medline].

  27. Finger PT. Radiation therapy for choroidal melanoma. Surv Ophthalmol. Nov-Dec 1997;42(3):215-32. [Medline].

  28. Finger PT, Berson A, Szechter A. Palladium-103 plaque radiotherapy for choroidal melanoma: results of a 7-year study. Ophthalmology. Mar 1999;106(3):606-13. [Medline].

  29. Finger PT, Lipka AC, Lipkowitz JL, et al. Failure of transpupillary thermotherapy (TTT) for choroidal melanoma: two cases with histopathological correlation. Br J Ophthalmol. Sep 2000;84(9):1075-6. [Medline].

  30. Finger PT, Romero JM, Rosen RB, et al. Three-dimensional ultrasonography of choroidal melanoma: localization of radioactive eye plaques. Arch Ophthalmol. Mar 1998;116(3):305-12. [Medline].

  31. Folberg R, Mehaffey M, Gardner LM, et al. The microcirculation of choroidal and ciliary body melanomas. Eye. 1997;11 (Pt 2):227-38. [Medline].

  32. Godfrey DG, Waldron RG, Capone A Jr. Transpupillary thermotherapy for small choroidal melanoma. Am J Ophthalmol. Jul 1999;128(1):88-93. [Medline].

  33. Gragoudas ES, Lane AM, Regan S, et al. A randomized controlled trial of varying radiation doses in the treatment of choroidal melanoma. Arch Ophthalmol. Jun 2000;118(6):773-8. [Medline].

  34. Grossniklaus HE, Albert DM, Green WR, et al. Clear cell differentiation in choroidal melanoma. COMS report no. 8. Collaborative Ocular Melanoma Study Group. Arch Ophthalmol. Jul 1997;115(7):894-8. [Medline].

  35. Grossniklaus HE, Wilson MW, Barron BC, et al. Anterior vs posterior intraocular melanoma. Metastatic differences in a murine model. Arch Ophthalmol. Sep 1996;114(9):1116-20. [Medline].

  36. Gunduz K, Shields CL, Shields JA, et al. Plaque radiotherapy for management of ciliary body and choroidal melanoma with extraocular extension. Am J Ophthalmol. Jul 2000;130(1):97-102. [Medline].

  37. Gunduz K, Shields CL, Shields JA, et al. Plaque radiotherapy of uveal melanoma with predominant ciliary body involvement. Arch Ophthalmol. Feb 1999;117(2):170-7. [Medline].

  38. Gunduz K, Shields CL, Shields JA, et al. Radiation complications and tumor control after plaque radiotherapy of choroidal melanoma with macular involvement. Am J Ophthalmol. May 1999;127(5):579-89. [Medline].

  39. Gupta M, Rennie IG. Orbital metastasis from a choroidal melanoma. Eye. Feb 2005;19(2):227-9. [Medline].

  40. Hawkins BS. The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma: IV. Ten-year mortality findings and prognostic factors. COMS report number 24. Am J Ophthalmol. Dec 2004;138(6):936-51. [Medline].

  41. Jakobiec FA, Coleman DJ, Chattock A, et al. Ultrasonically guided needle biopsy and cytologic diagnosis of solid intraocular tumors. Ophthalmology. Sep 1979;86(9):1662-81. [Medline].

  42. Kiratli H, Bilgiç S. Sequential development of bilateral primary choroidal melanoma. Acta Ophthalmol Scand. Aug 2000;78(4):474-6. [Medline].

  43. Kroll S, Char DH, Quivey J, et al. A comparison of cause-specific melanoma mortality and all-cause mortality in survival analyses after radiation treatment for uveal melanoma. Ophthalmology. Nov 1998;105(11):2035-45. [Medline].

  44. Maberly DA, Pavlin CJ, McGowan HD, et al. Ultrasound biomicroscopic imaging of the anterior aspect of peripheral choroidal melanomas. Am J Ophthalmol. Apr 1997;123(4):506-14. [Medline].

  45. Mafee MF, Puklin J, Barany M, et al. MRI and in vivo proton spectroscopy of the lesions of the globe. Semin Ultrasound CT MR. Dec 1988;9(6):428-42. [Medline].

  46. Makitie T, Summanen P, Tarkkanen A, et al. Microvascular density in predicting survival of patients with choroidal and ciliary body melanoma. Invest Ophthalmol Vis Sci. Oct 1999;40(11):2471-80. [Medline].

  47. Makitie T, Summanen P, Tarkkanen A, et al. Microvascular density in predicting survival of patients with choroidal and ciliary body melanoma. Invest Ophthalmol Vis Sci. Oct 1999;40(11):2471-80. [Medline].

  48. Marcus DM, Minkovitz JB, Wardwell SD, et al. The value of nucleolar organizer regions in uveal melanoma. The Collaborative Ocular Melanoma Study Group. Am J Ophthalmol. Nov 15 1990;110(5):527-34. [Medline].

  49. McLean IW, Ainbinder DJ, Gamel JW, et al. Choroidal-ciliary body melanoma. A multivariate survival analysis of tumor location. Ophthalmology. Jul 1995;102(7):1060-4. [Medline].

  50. McLean IW, Zimmerman LE, Evans RM. Reappraisal of Callender's spindle a type of malignant melanoma of choroid and ciliary body. Am J Ophthalmol. Oct 1978;86(4):557-64. [Medline].

  51. McLean MJ, Foster WD, Zimmerman LE. Prognostic factors in small malignant melanomas of choroid and ciliary body. Arch Ophthalmol. Jan 1977;95(1):48-58. [Medline].

  52. Mehaffey MG, Gardner LM, Folberg R. Distribution of prognostically important vascular patterns across multiple levels in ciliary body and choroidal melanomas. Am J Ophthalmol. Sep 1998;126(3):373-8. [Medline].

  53. Meredith TA. Choroidal melanoma: diagnosis and management. Am J Ophthalmol. Jun 1998;125(6):865-7. [Medline].

  54. Meyer A, Levy C, Blondel J, et al. [Optic neuropathy after proton-beam therapy for malignant choroidal melanoma]. J Fr Ophtalmol. Jun 2000;23(6):543-53. [Medline].

  55. Midena E, de Belvis V, Dei Tos AP, et al. Isolated brain metastasis of malignant choroidal melanoma 27 years after enucleation. Arch Ophthalmol. Nov 1999;117(11):1553-6. [Medline].

  56. Missotten L, Dirven W, Van der Schueren A, et al. Results of treatment of choroidal malignant melanoma with high-dose- rate strontium-90 brachytherapy. A retrospective study of 46 patients treated between 1983 and 1995. Graefes Arch Clin Exp Ophthalmol. Mar 1998;236(3):164-73. [Medline].

  57. Mueller AJ, Folberg R, Freeman WR, et al. Evaluation of the human choroidal melanoma rabbit model for studying microcirculation patterns with confocal ICG and histology. Exp Eye Res. Jun 1999;68(6):671-8. [Medline].

  58. Oosterhuis JA, Journee-de Korver HG, Keunen JE. Transpupillary thermotherapy: results in 50 patients with choroidal melanoma. Arch Ophthalmol. Feb 1998;116(2):157-62. [Medline].

  59. Rummelt V, Folberg R, Rummelt C, et al. Microcirculation architecture of melanocytic nevi and malignant melanomas of the ciliary body and choroid. A comparative histopathologic and ultrastructural study. Ophthalmology. Apr 1994;101(4):718-27. [Medline].

  60. Rummelt V, Folberg R, Woolson RF, et al. Relation between the microcirculation architecture and the aggressive behavior of ciliary body melanomas. Ophthalmology. May 1995;102(5):844-51. [Medline].

  61. Rummelt V, Mehaffey MG, Campbell RJ, et al. Microcirculation architecture of metastases from primary ciliary body and choroidal melanomas. Am J Ophthalmol. Aug 1998;126(2):303-5. [Medline].

  62. Sabetti L, Toscano A, Specchia G, et al. Neoplasia-like echographic evidence in retinopathies of several aetiologies: a case report. Ophthalmologica. 1998;212 Suppl 1:93-4. [Medline].

  63. Scott IU, Murray TG, Hughes JR. Evaluation of imaging techniques for detection of extraocular extension of choroidal melanoma. Arch Ophthalmol. Jul 1998;116(7):897-9. [Medline].

  64. Scotto J, Fraumeni JF Jr, Lee JA. Melanomas of the eye and other noncutaneous sites: epidemiologic aspects. J Natl Cancer Inst. Mar 1976;56(3):489-91. [Medline].

  65. Shields CL, Ganguly A, Materin MA, et al. 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. Aug 2007;125(8):1017-24. [Medline].

  66. Shields CL, Shields JA. Transpupillary thermotherapy for choroidal melanoma. Curr Opin Ophthalmol. Jun 1999;10(3):197-203. [Medline].

  67. Shields CL, Shields JA, Cater J, Augsburger JJ. Transpupillary thermotherapy for choroidal melanoma: tumor control and visual results in 100 consecutive cases. Ophthalmology. Apr 1998;105(4):581-90. [Medline].

  68. Shields CL, Shields JA, De Potter P, et al. Diffuse choroidal melanoma. Clinical features predictive of metastasis. Arch Ophthalmol. Aug 1996;114(8):956-63. [Medline].

  69. Shields CL, Shields JA, Shields MB, et al. Prevalence and mechanisms of secondary intraocular pressure elevation in eyes with intraocular tumors. Ophthalmology. Jul 1987;94(7):839-46. [Medline].

  70. Shields JA, Augsburger JJ. Cataract surgery and intraocular lenses in patients with unsuspected malignant melanoma of the ciliary body and choroid. Ophthalmology. Jun 1985;92(6):823-6. [Medline].

  71. Shields JA, Shields CL. Current management of posterior uveal melanoma. Mayo Clin Proc. Dec 1993;68(12):1196-200. [Medline].

  72. Shields JA, Shields CL. Massive orbital extension of posterior uveal melanomas. Ophthal Plast Reconstr Surg. 1991;7(4):238-51. [Medline].

  73. Shields JA, Shields CL, De Potter P, et al. Diagnosis and treatment of uveal melanoma. Semin Oncol. Dec 1996;23(6):763-7. [Medline].

  74. Shields JA, Shields CL, Gunduz K, et al. Adenoma of the ciliary body pigment epithelium: the 1998 Albert Ruedemann, Sr, memorial lecture, Part 1. Arch Ophthalmol. May 1999;117(5):592-7. [Medline].

  75. The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma I: characteristics of patients enrolled and not enrolled. COMS report no. 9. Am J Ophthalmol. Jun 1998;125(6):767-78. [Medline].

  76. Umlas J, Diener-West M, Robinson NL, et al. Comparison of transillumination and histologic slide measurements of choroidal melanoma. Arch Ophthalmol. Apr 1997;115(4):474-7. [Medline].

  77. Yanoff M. Mechanisms of glaucoma in eyes with uveal malignant melanomas. Int Ophthalmol Clin. Spring 1972;12(1):51-62. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

choroidal melanoma, malignant choroidal melanoma, intraocular tumor, intraocular melanoma, malignant tumor, malignant melanoma, uveal melanoma, primary malignant melanoma, anterior choroidal melanoma, posterior choroidal melanoma, anterior uveal melanoma, posterior uveal melanoma, uvea, iris, choroid, ciliary body, uveal structure

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Enrique Garcia-Valenzuela, MD, PhD, Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center
Enrique Garcia-Valenzuela, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Retina Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

Coauthor(s)

Mauricio E Pons, MD, Associate Physician, Charles A Garcia, MD, PA
Mauricio E Pons, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

James E Puklin, MD, Professor, Department of Ophthalmology, Vitreoretinal Service, Kresge Eye Institute, Wayne State University
Disclosure: Nothing to disclose.

Cathleen A Davidson, MSc, Consulting Staff, Department of Obstetrics and Gynecology, Laboratory of Assisted Reproductive Technologies, University of Michigan
Disclosure: Nothing to disclose.

Medical Editor

Russell P Jayne, MD, Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas
Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, and American Society of Retina Specialists
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.