Uveal Melanoma: Evidence for Efficacy of Therapy

Armin R. Afshar, MD, MBA; Bertil E. Damato, MD, PhD


Int Ophthalmol Clin. 2015;55(1):23-43. 

In This Article

Abstract and Introduction


More than 90% of all uveal melanomas involve the choroid, with the remainder being confined to the ciliary body and/or iris.[1–3] Melanomas involving the choroid cause visual loss as a result of retinal pigment epitheliopathy overlying the tumor and serous retinal detachment. Ciliary body tumors can also cause astigmatism and cataract formation. Tumors in the anterior chamber can cause glaucoma with secondary visual loss. The eye can become painful as a result of neovascular glaucoma or uveitis. There can be extraocular spread into the episclera or orbit, causing proptosis. If neglected, uveal melanomas can form a fungating mass and can spread posteriorly to the brain. Almost 50% of all patients with uveal melanoma develop metastatic disease, which usually involves the liver and is nearly always fatal.[4] Metastatic disease occurs almost exclusively in patients whose tumor shows chromosome 3 loss and/or a class 2 gene-expression profile. These abnormalities are highly lethal, with survival time correlating inversely with basal tumor diameter and mitotic count.[5,6]

The objectives of ocular treatment are to prevent metastatic spread, and if possible, to conserve the eye and useful vision. Eye-conserving therapeutic modalities include various forms of phototherapy, radiotherapy and local resection, which can be administered individually or in combination. Patient care also includes education, prognostication, counseling, and emotional support, to enhance quality of life.

The aims of this review are: (1) to discuss the efficacy of ocular treatment in terms of local tumor control, preservation of vision, ocular conservation, quality of life, and survival; and (2) to discuss the evidence currently available. It is assumed that the reader is familiar with the therapeutic modalities mentioned in this review.