Case #66: Part 3 – Amelanotic Malignant Uveal Melanoma – Page 17 of 17
Acknowledgements Thank you to Dr. Jerry Sherman and Dr. Carol Shields for providing the case study and images!
Acknowledgements Thank you to Dr. Jerry Sherman and Dr. Carol Shields for providing the case study and images!
About the Author Caroline Donato is an optometrist currently completing her residency in ocular disease at SUNY College of Optometry. She is a graduate of SUNY College of Optometry's class of 2023. Dr. Donato has a passion for the treatment and management of ocular disease, most prominently ocular manifestations of
ReferencesRusso A, Avitabile T, Reibaldi M, Bonfiglio V, Pignatelli F, Fallico M, Caltabiano R, Broggi G, Russo D, Varricchio S, et al. Iris Melanoma: Management and Prognosis. Applied Sciences. 2020; 10(24):8766.Shemesh, R., Bourla, N. & Vishnevskia-Dai, V. Characteristics of amelanotic iris lesions – a ten-year historical cohort. Graefes Arch Clin Exp Ophthalmol 262, 667–669
Clinical TakeawaysPatients with amelanotic lesions or atypical iris nevi should be followed closely to monitor for any subtle changes.Amelanotic iris lesions that exhibit suspicious properties should be referred promptly for evaluation by ocular oncology.Lesions that have grown in size and/or changed appearance should be biopsied.UBM, B-scan, and anterior segment OCT should be utilized to
TreatmentShields et al described that conversion of iris nevi to melanoma is:3% at 5 years4% at 10 years11% at 20 yearsLesions can be surgically excised if they remain anterior to the iris.Treatment with iodine radiotherapy can be indicated.Enucleation is necessary if the tumor does not remain local.Metastasis remains biggest risk.
DiagnosisThe diagnosis of amelanotic malignant melanoma was made.The patient was treated with iodine plaque therapy.The lesion initially regressed, but then the patient was again lost to follow up for her 6-month appointment.
Did this originate from the ciliary body or the iris?It is difficult to discern due to presence of the lesion both posterior to the iris at the ciliary body and anterior to the iris.Had the lesion metastasized during the time the patient was lost to follow up? UBM reveals a mass posterior to the
Referral The patient was then referred to ocular oncology due to the documented growth of the lesion. UBM imaging was obtained and showed lesion growth both anterior and posterior to the iris and ciliary body/angle involvement. Note: Elevations anterior and posterior to the iris on UBM
Gonioscopic view of the lesion shows extensive growth in the angle. It is also apparent that there is elevation present behind the iris pushing forward, presumably indicating that the lesion has further posterior growth.
There is a shadow of the lesion cast onto the iris. There is an extensive vascular network within the lesion itself.