Good Hope, Heartlands, and Solihull Eye Clinics

Melanomas and tumours of eye

David Kinshuck

Introduction

  • 6 million/year/UK (60m people) ocular melanoma
  • Overall mortality 50%
  • White causasians ..300 x more likely
  • Occasional oculomelanocytosis-naevus of ota 30 x risk
    • 2/3 choroid
    • 1/3 ciliary body
    • 1/20 iris

Iris melanomas

  • Iris..circumscribed 90% , diffuse 10%
  • Diffuse...harder to diagnose, may present as secondary to glaucoma
  • Most inferior..if upper half think again
  • treat withplaque

Circumscribed iris melanoma 

  • Ectropian uveae..often naevi NOT melanomas
  • Documented growth important
  • Differential diagnosis...freckle, naevi, melanoctoma, cyst, hamartoma, metastasis
  • a freckle does not disturb iris stroma
  • little dark blobs..? Melanocytoma, can enlarge and get glaucoma, but not melanomas
  • Irido-ciliary cysts, between iris and lens arec ommon, can be multiple, bilateral, seen on ubm and are not melanomas
  • Ciliary body..sentinel vessels - tumour llikely

Retinal Naevi

  • 1/20 normal
  • Drusen on surface
  • Slate grey,oct just in choroid, no elevation of retina
  • Halo around naevus, with pigmented centre, pale edge

Indeterminate melanocytic lesion

  • raised sclerotic, slow grow, with pigment, 1/25 melanomas
  • 0.5% metastasis

Melanotcytoma

  • juxtapapilary,  2% malignant 

Choroidal haemoangioma

  • ill defined border,
  • some aresturge weber
  • Bscan: high internal reflectivity unlike melanoma

Congenital hypertrophy of the retinal pigment epithelium (Chrpes)

  • Very dark, isolated, grouped, much more common peripherally,
  • if posterior pole think again,
  • deep pigment, grow, not malignant
  • Lacunae with age
  • Grouped...termed bear track
  • page

Choroidal osteomas

  • unilateral often, female, peripapillary
  • Grow , calcify, decalcify, get cnv in half

Retinal vasoproliferative tumours

  • primary
  • or secondary, eg retinitis pigmentosa and ushers
  • Some bilateral, general peripheral...inferior temporal
  • Exudate around..can explain an unexplained macular problem, half vpt...macula problems

Secondaries

  • 10% with disseminated cancer
  • look in the other eye for further cancer
  • Oct very helpful..irregular contour...metastasis...knobbly
  • some secondary to skin melanoma...metasis in vitreous..only tumour that does
  • need to treat as patient survives

Melanoma follow up & radiation retinopathy

  • Yearly liver usg/mri. Eye magazine 15                                                                                            
  • Antivegf for radiation retinopathy..have to keep injecting