What is the role of block excision in the treatment of choroidal melanoma?

Updated: Feb 18, 2020
  • Author: Enrique Garcia-Valenzuela, MD, PhD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Block excision (sclerouvectomy), is an alternative treatment method for choroidal melanomas. It is reserved for small tumors covering less than 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 about 15-20% of cases, local reappearance of the melanoma necessitates subsequent treatment, usually enucleation.

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