Answer
Answer
Several ocular modes of treatment are available for choroidal melanomas, as follows:
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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
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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 for which other therapies tend to fail
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Plaque brachytherapy is a widely accepted alternative to enucleation for medium-sized posterior uveal melanomas (< 10 mm in height and < 15 mm in diameter)
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External beam irradiation with protons or helium ions is a frequently used alternative for the treatment of medium-sized choroidal melanomas, although it has been used for larger tumors
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Pars plana vitrectomy endoresection
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Block excision (sclerouvectomy) is an alternative treatment method reserved for small tumors covering less than one third of the globe’s circumference
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Laser photocoagulation and transpupillary thermotherapy are used to treat selected small choroidal melanomas that are located away from the fovea and are less than 3 mm in thickness
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Orbital exenteration is a radical treatment reserved for cases with widespread orbital extension; it should be considered only in rare cases where marked discomfort is associated with massive orbital spread of the melanoma
Adjuvant systemic chemotherapy is not advocated.
When distant metastases are found during the initial systemic workup or later in the disease course, systemic chemotherapy is the primary treatment. In addition to standard chemotherapeutic agents, several FDA-approved immunotherapy options are currently available, including immunomodulators and oncolytic virus therapy for advanced malignant melanoma.
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Media Gallery
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Color photograph of a dome-shaped choroidal melanoma.
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Early fluorescein angiogram of choroidal melanoma showing intrinsic vascularity.
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Late fluorescein angiogram of choroidal melanoma showing early diffuse staining.
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B-scan ultrasound showing acoustic hollowing and uveal excavation in posterior choroidal melanoma.
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A-scan ultrasound of choroidal melanoma showing low-to-medium internal reflectivity.
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B-scan ultrasound showing acoustic hollowing in intraorbital extension of a posterior choroidal melanoma.
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T2-weighted MRI showing a small anterior choroidal melanoma in the left eye.
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Transpupillary photograph showing a posterior choroidal melanoma.
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Photograph showing an enucleated eye with advanced choroidal melanoma with transscleral extension.
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Histologic section of an enucleated eye showing a large dome-shaped choroidal melanoma.
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Histologic section of an enucleated eye showing a medium-sized mushroom-shaped choroidal melanoma with associated exudative retinal detachment.
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Choroidal melanoma. Histologic section showing spindle A cells in a uveal nevus.
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Choroidal melanoma. Histologic section showing spindle B cells in a uveal melanoma.
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Choroidal melanoma. Histologic section showing epithelioid cells in a uveal melanoma.
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Photograph showing a skin metastasis of a posterior choroidal melanoma.
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Intraoperative photograph showing placement of a radioactive plaque for posterior choroidal melanoma.
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