What is included in long-term monitoring of choroidal melanoma?

Answer

Irrespective of the treatment modality chosen, patients with choroidal melanomas need to be observed carefully and for many years. This is particularly true for small tumors, when the diagnosis is not established clearly. Close observation and measurement of the dimensions of the tumors with any of the diagnostic tools mentioned earlier is critical.

Repeat examinations usually are performed about every 3 months initially, and if no changes are seen, follow-up care is performed every 6 months. If growth of the lesion is detected, consider further treatment. Choroidal 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.

Repeat examinations and imaging tests are performed after all treatment modalities because of the possibility of intraocular or extraocular tumor recurrence. Follow-up care in patients with treated choroidal melanomas should include thorough physical examinations, liver function tests, and imaging of lungs, repeated about every 6-12 months. Early detection of distant metastases may affect management and survival.

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Media Gallery

Color photograph of a dome-shaped choroidal melanoma.
Early fluorescein angiogram of choroidal melanoma showing intrinsic vascularity.
Late fluorescein angiogram of choroidal melanoma showing early diffuse staining.
B-scan ultrasound showing acoustic hollowing and uveal excavation in posterior choroidal melanoma.
A-scan ultrasound of choroidal melanoma showing low-to-medium internal reflectivity.
B-scan ultrasound showing acoustic hollowing in intraorbital extension of a posterior choroidal melanoma.
T2-weighted MRI showing a small anterior choroidal melanoma in the left eye.
Transpupillary photograph showing a posterior choroidal melanoma.
Photograph showing an enucleated eye with advanced choroidal melanoma with transscleral extension.
Histologic section of an enucleated eye showing a large dome-shaped choroidal melanoma.
Histologic section of an enucleated eye showing a medium-sized mushroom-shaped choroidal melanoma with associated exudative retinal detachment.
Choroidal melanoma. Histologic section showing spindle A cells in a uveal nevus.
Choroidal melanoma. Histologic section showing spindle B cells in a uveal melanoma.
Choroidal melanoma. Histologic section showing epithelioid cells in a uveal melanoma.
Photograph showing a skin metastasis of a posterior choroidal melanoma.
Intraoperative photograph showing placement of a radioactive plaque for posterior choroidal melanoma.

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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, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists, Retina Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Coauthor(s)

Mauricio E Pons, MD Associate Physician, California Retina Associates

Mauricio E Pons, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists

Disclosure: Nothing to disclose.

James E Puklin, MD Professor, Department of Ophthalmology, Chair, Human Investigation Committee, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Cathleen A Davidson, MSc Clinical Staff, Department of Obstetrics and Gynecology, Laboratory of Assisted Reproductive Technologies (ART), University of Michigan Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Additional Contributors

Russell P Jayne, MD 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, American Society of Retina Specialists

Disclosure: Nothing to disclose.

What is included in long-term monitoring of choroidal melanoma?

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