Year: 2010
Type: dissertation
Abstract: Uveal melanoma (UM) is the most common primary intraocular malignancy in adults\nwith an incidence of 7-10/ million and has a predilection for hematogenous dissemination\nto the liver. Despite improvements in diagnosis and treatment of this intraocular\ntumor, there has not been a change in survival in the past decades. There is no effective\ntreatment for liver metastases resulting in tumor-related death in about 45% of UM\npatients within 15 years after the initial diagnosis.\nUveal melanoma usually arises ‘de novo’ from melanocytes derived from neural crest\ncells that have migrated to the epidermis and uveal tract during embryogenesis. Intraocular\nmelanoma may arise in the choroid (70-80%), ciliary body (10-20%) and iris\n(5-10%). Iris melanomas are the least common and tend to present at a smaller size,\nprobably because pigmented lesions of the iris are usually visible to the patient. Iris melanomas\ncan cause drainage angle blockage and secondary elevation of the intraocular\npressure.4 Melanomas located in the ciliary body are associated with a high metastatic\npotential. Choroidal melanomas compromise the majority and grow subretinal in a\ndiscoid, dome-shaped or mushroom-shaped pattern.\nThe diagnosis is based on the clinical appearance of the tumor on ophthalmic examination.\nAncillary tests include (Doppler-) ultrasonography, transillumination, fluorescein\nangiography and optical coherence tomography. For the diagnosis of melanoma, biopsy\nis reserved for tumors of uncertain origin. Conversely, tumor biopsy gains territory in\nvision-sparing therapies for cytogenetic analysis providing risk assessment of metastatic\ndisease.\nUpon diagnosis of the primary tumor, patients are screened for metastases by liver\nenzyme tests and liver ultrasound. At time of diagnosis less than 2% of the patients have\ndetectable metastases.
Author: Hanneke W. Mensink
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1551347530