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References: Finger PT: Plaque radiation therapy for malignant melanoma of the iris and ciliary body. Am J Ophthalmol 132 (3): 328-35, 2001.Char DH, Miller T, Crawford JB: Uveal tumour resection. Br J Ophthalmol 85 (10): 1213-9, 2001.De Potter P: [Choroidal melanoma: current therapeutic approaches] J Fr Ophtalmol 25 (2): 203-11, 2002.Costache M, Patrascu OM,
Acknowledgement Thank you to Dr. Jerry Sherman for providing this case study and images. Jerome Sherman, OD, FAAOSUNY Distinguished Teaching Professor
About the Author Dr. Diana Doscas is a graduate of SUNY Optometry Class of 2023 from Mahopac, NY. Dr. Doscas is currently a resident in Primary Care Optometry/Ocular Disease at the VA Hudson Valley Health Care System in Hudson Valley, New York.
Clinical Takeaways: Ciliary Body Melanoma Uveal melanomas are the most common primary intraocular tumor in adults (90% of these are in the choroid)Ciliary body melanomas often remain asymptomatic until large in size which delays diagnosis, increasing chance of metastasisPrognosis is poor once the tumor has disseminatedChanges to iris appearance with associated
Back to the Case: The patient was referred for a systemic workup to evaluate for metastasisEnucleation was recommended over radiation due to the size and thickness of the lesionThe patient underwent enucleation and no metastasis had been detected 15 months after eye removal
Treatment Options: Ciliary body melanomas cause partial or total visual loss from direct pathological involvement OR as a result of the treatment usedPlaque radiation therapyExternal beam, charged-particle radiation therapyLocal tumor resectionEnucleation
Prognosis: Patients who die from ciliary body melanoma die because of distant metastasis, not local spreadFrequently disseminates before diagnosisOverall mortality rate of ciliary body melanoma is 30-50% within 10 years of diagnosisCiliary body and anterior choroidal melanomas have worse prognosis than posterior choroidal melanomasPossible reasons=delayed diagnosis or easier regional path to hematogenous spreadIncreased vascularization=worse
Risk Factors: Sporadic eventLight iris colorLight skin colorNorthern European ancestryPredisposing Conditions:Uveal nevusCongenital ocular melanocytosisXeroderma pigmentosumDysplastic nevus syndrome
Epidemiology: Incidence of primary intraocular melanoma in United States is 4.3-6 cases per 1 million per yearCiliary body melanoma represents 1/10th of these casesHigher in Southern US (more sunlight exposure, older Americans tend to retire South)Incidence high in Demark and other Scandinavian countries97.8% of cases occur in White patientsExtremely rare in
Diagnostic Imaging B-scan UBM MRI and Histological Examination
