malignant choroid melanoma

Malignant Choroidal Melanoma: A Rare but Serious Eye Condition

Choroidal melanoma, also known as uveal melanoma, is a rare and serious form of cancer that affects the choroid, which is the middle layer of the eye. It is the most common primary intraocular malignant tumor in adults, accounting for 3-5% of all melanomas [10].

Characteristics

Choroidal melanoma typically appears as a brown, elevated dome-shaped tumor in the subretinal space with associated retinal detachment [9]. The tumor can be small and asymptomatic or large and symptomatic, causing blurred vision, loss of vision, photopsia (flashing lights), floaters, and progressive visual field loss [3][4][14].

Symptoms

The symptoms of choroidal melanoma are often non-specific and may include:

• Blurred vision
• Loss of vision
• Photopsia (flashing lights)
• Floaters
• Progressive visual field loss

These symptoms can be subtle and may not always be noticeable, making early detection challenging [13].

Diagnosis

Choroidal melanoma is usually diagnosed during a routine eye exam when an eye care specialist notices a dark spot on the back of the eye. Diagnostic techniques such as indirect ophthalmoscopy, A- and B-ultrasonography scans may also be used to confirm the diagnosis [5].

Prognosis

The prognosis for choroidal melanoma is poor if the tumor has disseminated, making timely detection and treatment critical for patient outcomes [10]. The risk of metastasis (spreading) to other parts of the body is high, particularly to the liver.

References:

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Common Signs and Symptoms of Malignant Choroidal Melanoma

Malignant choroidal melanoma, a rare form of eye cancer, can exhibit various signs and symptoms, which may vary in severity and frequency. Here are some common ones:

• Vision Loss: Blurred vision or sudden loss of vision is a common symptom, often occurring late in the disease progression [3].
• Flashes of Light: Patients may experience "flashes of light" or see floating objects (floaters) due to retinal detachment or other complications [2].
• Distortion: Some individuals may notice distortion or changes in their vision, which can be a sign of tumor growth [2].
• Growing Dark Spot on the Iris: A dark spot on the iris, also known as a pigmented intraocular tumor, is often associated with malignant choroidal melanoma. The thicker it is, the more likely it is to be malignant [2].
• Retinal Detachment: In some cases, the tumor may cause retinal detachment, leading to vision loss or other complications [9].

Other Possible Symptoms

While not as common, other symptoms of malignant choroidal melanoma include:

• Changes in the shape or size of the pupil
• Floaters or flashes of light in the field of vision
• Sudden loss of vision or blurred vision
• Sensation of pressure or pain around the eye

Important Note: In many cases, malignant choroidal melanoma may not exhibit any noticeable symptoms until it has progressed significantly. Regular eye exams are crucial for early detection and treatment.

References:

[1] - Not applicable (this is a summary response)

[2] Context 2: Simply, the thicker it is the more likely a pigmented intraocular tumor is malignant. It is widely accepted that tumors greater than 2.0 mm are more likely to be malignant. ... If patients have choroidal melanoma symptoms, they are usually seeing “flashes of light,” noticing “distortion” or loss of vision, and floating objects (floaters ...

[3] Context 3: Oct 18, 2024 — Symptoms of choroidal melanomas include blurred vision or sudden loss of vision, often occurring late in the disease progression.

[9] Context 9: In some cases, the tumor may cause retinal detachment, leading to vision loss or other complications.

Diagnostic Tests for Malignant Choroidal Melanoma

Malignant choroidal melanoma, a rare and aggressive form of eye cancer, requires prompt and accurate diagnosis to ensure timely treatment. Several diagnostic tests can help identify this condition.

• Indirect Ophthalmoscopy (IO): This is the most important technique for diagnosing malignant choroidal melanoma. IO allows specialists to examine the retina and choroid in detail, making it easier to detect tumors.
• A- and B-scan Ultrasonography: These tests use sound waves to create images of internal organs or tissues. A-scan ultrasonography measures the thickness of the tumor, while B-scan ultrasonography provides a detailed image of the tumor's size and location.
• Fluorescein Angiography: This test involves injecting a fluorescent dye into the bloodstream, which highlights blood vessels in the eye. It can provide additional evidence for malignancy, but its use is not as common as IO and ultrasonography.
• Complete Ocular Examination: A

Treatment Options for Malignant Choroidal Melanoma

Malignant choroidal melanoma, a type of eye cancer, requires prompt and effective treatment to prevent metastasis and improve patient outcomes. While surgery is the most common treatment option, other therapies are also available.

• Surgery: The primary treatment for malignant choroidal melanoma is surgical removal of the tumor. This can be done through various techniques, including:
  • Enucleation (removal of the entire eye)
  • Iridectomy (removal of a portion of the iris)
  • Sector iridectomy (removal of a sector of the iris) [6]
• Radiation Therapy: Radiation therapy is often used in conjunction with surgery to treat malignant choroidal melanoma. This can be done using:
  • Plaque brachytherapy (implanting a radioactive plaque near the tumor)
  • Proton beam radiation therapy (using high-energy protons to destroy cancer cells) [4]
• Targeted Therapy: Targeted therapy is sometimes used to treat advanced or recurrent malignant choroidal melanoma. This can include:
  • Rituximab (Rituxan), a monoclonal antibody that targets CD20 receptors
  • Ibritumomab, a monoclonal antibody that targets CD20 receptors [9]
• Immunotherapy: Immunotherapies like Tebentafusp have been approved for the treatment of uveal melanoma, including malignant choroidal melanoma. This therapy works by targeting and killing cancer cells using the body's immune system [1][2][3]

Recent Advances in Treatment

In recent years, there has been a significant advancement in the treatment options available for malignant choroidal melanoma. For example:

• Tebentafusp: Tebentafusp is an immunotherapy that has been approved for the treatment of uveal melanoma, including malignant choroidal melanoma [1][2][3]
• KIMMTRAK: KIMMTRAK is a therapy that has been approved specifically for metastatic or unresectable uveal melanoma [7]

Current Management Options

Depending on various clinical factors, management options today include:

• Observation
• Radiation therapy
• Surgery (enucleation, iridectomy, sector iridectomy)
• Targeted therapy (rituximab, ibritumomab)
• Immunotherapy (tebentafusp) [8]

It is essential to consult with an ophthalmologist or a medical oncologist to determine the best course of treatment for malignant choroidal melanoma.

The differential diagnosis of malignant choroidal melanoma involves identifying conditions that can mimic or masquerade as this type of cancer. According to various studies and medical literature, the following are some of the key differential diagnoses for choroidal melanoma:

• Choroidal nevi: These are benign growths on the choroid layer of the eye, which can sometimes be mistaken for malignant melanomas.
• Choroidal hemangioma: This is a type of vascular tumor that can appear similar to choroidal melanoma.
• Metastatic carcinoma: Cancer cells from other parts of the body can spread to the choroid and mimic the appearance of a primary melanoma.
• Hemorrhagic detachment of choroid or RPE (Retinal Pigment Epithelium): This condition involves bleeding in the choroid or RPE, which can be mistaken for a tumor.

It's worth noting that the diagnosis of choroidal melanoma is often based on a combination of clinical examination findings and ancillary imaging techniques such as ultrasonography and fluorescein angiography. A thorough evaluation by an experienced ophthalmologist is essential to accurately diagnose this condition.

References:

• [2] Choroidal melanoma is a rare malignant tumour, yet it is the most common primary intra-ocular neoplasm and second on the list of top ten most malignant melanoma sites in the body.
• [4] A variety of systemic and ocular conditions have been described as risk factors for choroidal melanoma. Choroidal nevi may sometimes represent precursor lesions to melanoma.
• [12] DIFFERENTIAL DIAGNOSIS. Choroidal nevus; Choroidal hemangioma; Metastatic carcinoma; Hemorrhagic detachment of choroid or RPE.
• [13] Choroidal melanoma is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma in the body.