eMedicine Specialties > Ophthalmology > Iris & Ciliary Body

Melanoma, Ciliary Body: Follow-up

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 in Private Practice, Charles A Garcia, MD, PA; Christopher M Bardorf, MD, MS, Ophthalmology, Children's Eye Physicians, Denver, CO; Dean Eliott, MD, Associate Professor, Department of Ophthalmology, Division of Vitreoretinal Surgery, Kresge Eye Institute, Wayne State University
Contributor Information and Disclosures

Updated: Jan 10, 2007

Follow-up

Further Outpatient Care

  • Irrespective of the treatment modality chosen, patients with ciliary body melanomas need to be monitored carefully for many years. This is particularly true for small ciliary body tumors, when the diagnosis is not clearly established. Close observation and measurement of the tumor dimensions with any of the diagnostic tools mentioned earlier is critical.
  • Repeat examinations are usually performed about every 3 months initially, and if no changes are seen, follow-up care is completed every 6 months. If growth of the lesion is detected, consider further treatment.
  • Ciliary body melanomas may show size regression starting several months after being treated with external beam irradiation or plaque brachytherapy. The goal of successful treatment is not necessarily reduction in size but long-term arrest of the tumor's growth.
  • Because of the possibility of intraocular or extraocular tumor recurrence, repeat examinations and imaging tests are performed after all treatment modalities.
  • Follow-up care in patients with treated ciliary body melanomas should include thorough physical examinations, liver function tests, and imaging of the lungs, repeated about every 6-12 months. Early detection of distant metastases may affect management and survival.

Deterrence/Prevention

  • Patients with choroidal nevi, family history of uveal melanoma, congenital ocular melanocytosis, dysplastic nevus syndrome, and other predisposing conditions of uveal melanoma may benefit from annual careful ophthalmologic examinations.
  • Limiting excessive ocular sunlight exposure through sunglasses or other means may have a theoretical preventive effect in patients with predisposition to intraocular melanoma.

Complications

  • The tumor or the treatment can cause a variety of ocular complications that severely affect vision, as discussed in Pathophysiology and Treatment.

Prognosis

  • Visual prognosis is guarded for melanomas in the ciliary body.
    • Ciliary body melanomas have an overall mortality of about 30-50% within 10 years from initial diagnosis and treatment.
    • Deaths are mostly secondary to distant metastases.
    • Melanomas in the ciliary body have worse prognosis for survival than those in other uveal locations. Possible reasons include delayed diagnosis as the tumor is hidden behind the iris diaphragm and an easier regional path to hematogenous spread, perhaps facilitated by the continuous contractions of the ciliary-iris muscles.
    • An additional factor found to correlate with worse survival prognosis of ciliary body melanomas is their increased vascularization.

Miscellaneous

Medicolegal Pitfalls

  • Three circumstances put ciliary body melanoma in a special category regarding medical legal liability, as follows:
    • Diagnosis of ciliary body melanoma often is delayed because of its insidious development.
    • Ciliary body melanoma is rare, and it tends to be last among the differential diagnoses.
    • Ciliary body melanoma is a disease with a high mortality rate, usually irrespective of the chosen treatment modality.
 


More on Melanoma, Ciliary Body

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

References

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

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

  3. 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].

  4. Biswas J, Kumar SK, Gopal L, Bhende MP. Leiomyoma of the ciliary body extending to the anterior chamber: clinicopathologic and ultrasound biomicroscopic correlation. Surv Ophthalmol. Jan-Feb 2000;44(4):336-42. [Medline].

  5. COMS Report. 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].

  6. COMS Report. 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].

  7. COMS Report. 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].

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

  9. COMS Report. 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].

  10. 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].

  11. Char DH, Kroll S, Quivey JM, Castro J. 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].

  12. 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].

  13. Decker M, Castro JR, Linstadt DE, et al. Ciliary body melanoma treated with helium particle irradiation. Int J Radiat Oncol Biol Phys. Aug 1990;19(2):243-7. [Medline].

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

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

  16. 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].

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

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

  19. 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].

  20. Hu DN. Photobiology of ocular melanocytes and melanoma. Photochem Photobiol. May-Jun 2005;81(3):506-9. [Medline].

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

  22. Jonas JB, Groh MJ, Rummelt V, Naumann GO. Rhegmatogenous retinal detachment after block excision of epithelial implantation cysts and tumors of the anterior uvea. Ophthalmology. Oct 1999;106(10):1942-6. [Medline].

  23. Khoury JM, O'Day DM. Retained intraocular metallic foreign body masquerading as a ciliary body melanoma with extrascleral extension. Arch Ophthalmol. Mar 1999;117(3):410-1. [Medline].

  24. Kroll S, Char DH, Quivey J, Castro J. 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].

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

  26. 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].

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

  28. Marcus DM, Minkovitz JB, Wardwell SD, Albert DM. 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].

  29. Marigo FA, Finger PT, McCormick SA, et al. Iris and ciliary body melanomas: ultrasound biomicroscopy with histopathologic correlation. Arch Ophthalmol. Nov 2000;118(11):1515-21. [Medline].

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

  31. 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].

  32. 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].

  33. 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].

  34. Nguyen QD, Foster CS. Ciliary body melanoma masquerading as chronic uveitis. Ocul Immunol Inflamm. Dec 1998;6(4):253-6. [Medline].

  35. 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].

  36. 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].

  37. 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].

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

  39. Scott CT, Holland GN, Glasgow BJ. Cavitation in ciliary body melanoma. Am J Ophthalmol. Feb 1997;123(2):269-71. [Medline].

  40. 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].

  41. Seregard S. Massive intracorneal invasion of a ciliary body melanoma. Acta Ophthalmol (Copenh). Apr 1994;72(2):257-9. [Medline].

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

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

  44. Shields JA, Shields CL, Gunduz K, Eagle RC Jr. 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].

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

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

  47. 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].

  48. Singh AD, Topham A. Incidence of uveal melanoma in the United States: 1973-1997. Ophthalmology. May 2003;110(5):956-61. [Medline].

  49. Smith PA, Damato BE, Ko MK, Lyness RW. Anterior uveal neurilemmoma--a rare neoplasm simulating malignant melanoma. Br J Ophthalmol. Jan 1987;71(1):34-40. [Medline].

  50. Terasaki H, Miyake Y, Awaya S, et al. Identification of anterior uveal tumor border by transscleral transillumination and an ophthalmic endoscope. Am J Ophthalmol. Jan 1997;123(1):138-40. [Medline].

  51. Thaller VT, Perinti A, Perinti A. Benign schwannoma simulating a ciliary body melanoma. Eye. 1998;12 ( Pt 1):158-9. [Medline].

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

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

ciliary body melanoma, ciliary body malignant melanoma, uveal melanoma, intraocular tumor, intraocular melanoma, uvea, iris, ciliary body, choroid

[ 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 in Private Practice, 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.

Christopher M Bardorf, MD, MS, Ophthalmology, Children's Eye Physicians, Denver, CO
Christopher M Bardorf, MD, MS is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Dean Eliott, MD, Associate Professor, Department of Ophthalmology, Division of Vitreoretinal Surgery, Kresge Eye Institute, Wayne State University
Dean Eliott, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
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
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

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.