eMedicine Specialties > Ophthalmology > Iris & Ciliary Body

Melanoma, Iris: Treatment & Medication

Author: Nadia K Waheed, MD, Consulting Staff, Department of Vitreoretinal Disease, Cole Eye Institute/Cleveland Clinic Foundation
Coauthor(s): C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution
Contributor Information and Disclosures

Updated: Jul 11, 2008

Treatment

Medical Care

  • Patients are observed through periodic examinations, photographic documentation, and ultrasound biomicroscopy.
  • Glaucoma can be controlled by medication if no tumor infiltration of the angle structures is present.

Surgical Care

The treatment of choice for growing lesions has typically been excision. However, reports in the literature have described the successful treatment of these lesions with brachytherapy and proton beam irradiation.

  • Excision is recommended if the lesion is impinging on the pupillary margin and interfering with vision or if secondary glaucoma is not controlled with medication.
  • Excision should be considered if the lesion grows rapidly or encroaches on the chamber angle and/or if the fine-needle biopsy specimen shows malignant histology. Excision must be complete, either a sector iridectomy or an iridocyclectomy, if the lesion encroaches on the chamber angle.
  • Glaucoma filtration procedures should not be attempted because they may lead to seeding of the tumor cells and metastases.
  • Plaque radiation therapy with (103)Pd has been used for these patients. Preliminary results show a high rate of success, with the most common complication being cataract formation in more than 75% of phakic patients.

Consultations

Consultation with an oncologist is helpful if a metastatic lesion is suspected. Following surgery, patients must be monitored at least every 6 months for metastatic development.

More on Melanoma, Iris

Overview: Melanoma, Iris
Differential Diagnoses & Workup: Melanoma, Iris
Treatment & Medication: Melanoma, Iris
Follow-up: Melanoma, Iris
References
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References

  1. Shields JA, Sanborn GE, Augsburger JJ. The differential diagnosis of malignant melanoma of the iris. A clinical study of 200 patients. Ophthalmology. Jun 1983;90(6):716-20. [Medline].

  2. Torres VL, Allemann N, Erwenne CM. Ultrasound biomicroscopy features of iris and ciliary body melanomas before and after brachytherapy. Ophthalmic Surg Lasers Imaging. Mar-Apr 2005;36(2):129-38. [Medline].

  3. Jakobiec FA, Silbert G. Are most iris "melanomas' really nevi? A clinicopathologic study of 189 lesions. Arch Ophthalmol. Dec 1981;99(12):2117-32. [Medline].

  4. Arentsen JJ, Green WR. Melanoma of the iris: report of 72 cases treated surgically. Ophthalmic Surg. Summer 1975;6(2):23-37. [Medline].

  5. Ashton N. Primary tumours of the iris. Br J Ophthalmol. 1964;48.

  6. Ashton N, Wybar K. Primary tumours of the iris. Ophthalmologica. 1966;151(1):97-113. [Medline].

  7. Char DH. Anterior uveal tumors. Clinical Ocular Oncology. 1989.

  8. Damato B, Lecuona K. Conservation of eyes with choroidal melanoma by a multimodality approach to treatment: an audit of 1632 patients. Ophthalmology. May 2004;111(5):977-83. [Medline].

  9. Finger PT. Plaque radiation therapy for malignant melanoma of the iris and ciliary body. Am J Ophthalmol. Sep 2001;132(3):328-35. [Medline].

  10. Holland G. [On the clinical features and pathology of pigment tumors of the iris]. Klin Monatsbl Augenheilkd. Apr 1967;150(3):359-70. [Medline].

  11. Litricin O. Diffuse malignant ring melanoma of the iris and ciliary body. Ophthalmologica. 1979;178(4):235-8. [Medline].

  12. Rones B, Zimmerman LE. The production of heterochromia and glaucoma by diffuse malignant melanoma of the iris. Trans Am Acad Ophthalmol Otolaryngol. Jul-Aug 1957;61(4):447-63. [Medline].

  13. Rones B, Zimmerman LE. The prognosis of primary tumors of the iris treated by iridectomy. AMA Arch Ophthalmol. Aug 1958;60(2):193-205. [Medline].

  14. Rootman J, Gallagher RP. Color as a risk factor in iris melanoma. Am J Ophthalmol. Nov 1984;98(5):558-61. [Medline].

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Further Reading

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Keywords

iris melanoma, iris melanomas, iris nevus, iris nevi, iris tumors, tumors of the iris, iris lesions

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Contributor Information and Disclosures

Author

Nadia K Waheed, MD, Consulting Staff, Department of Vitreoretinal Disease, Cole Eye Institute/Cleveland Clinic Foundation
Nadia K Waheed, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution
C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi
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

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

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.

 
 
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