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Early detection, treatment key to management of choroidal melanoma, nevus
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BALTIMORE — Early detection and treatment and close long-term surveillance are critical for the management of choroidal nevus and melanoma, two experts told colleagues here.
“Prior to about 1970, enucleation was done for almost any lesion, regardless of its size, that was suspected to be possible melanoma,” Jerry A. Shields, MD, said at Macula 2013. “That’s undisputed. It was believed that that saved lives.”
Current techniques of treating choroidal melanoma include observation, transpupillary thermotherapy (TTT), episcleral plaque brachytherapy, combined plaque brachytherapy and TTT, charged particle irradiation, local resection, enucleation, orbital exenteration, tumor removal, chemotherapy and immunotherapy, Shields said.
In a poll of 400 retina specialists, 90% of respondents diagnosed borderline melanocytic lesions as melanoma and 10% diagnosed them as nevi, Shields said.
In a separate presentation, Carol L. Shields, MD, advised colleagues to be aware of conditions that mimic choroidal nevus, a potential precursor of choroidal melanoma.
Risk factors for conversion of nevus to melanoma include increased size, increased pigmentation and vision loss. One study showed that one in 8,845 cases of choroidal nevus transformed to choroidal melanoma, Shields said. However, increased size is not an absolute indicator of conversion to melanoma, she said.
“Imposters” of choroidal nevus include diffuse choroidal melanoma, subretinal hemorrhage, choroidal hemorrhage, congenital hypertrophy of the retinal pigment epithelium and combined hamartoma of the retina and retinal pigment epithelium.
“Beware of diffuse melanoma,” Shields said. “Prognosis is bad.”
Disclosure: Carol Shields and Jerry Shields have no relevant financial disclosures.