Aim: To assess prevalence and presentation of choroidal melanoma in a hill population of northern India along with its demographics, features, diagnostics, treatment and outcome with comparison to western population. Method: Choroidal melanoma constitutes most common intraocular malignancy with early appearance in Asian population. This is the 1st case series from a hill state of Uttarakhand, northern India involving medium to large size tumour with extraocular extension. In this retrospective study we assessed the prevalence, clinical presentation, diagnostic modalities, treatment plan, disease outcome, prognosis with survival and mortality. The study was carried out in time duration from February 2019- March 2021. Results: Data shows the presence of five patients, four male and 1 female in age range of 47-77 years, with median age at 62 years. Patient presented with visual equity in range of 6/18 to perception of light in time range of six months to 2 years. Fundus examination revealed presence of medium to large size choroidal mass with surface pigmentation and serous detachment. Neovascular glaucoma was present in three patients. Three patients underwent brachytherapy with I 125 and Ru 106, two cases responded well to therapy, one case presented with recurrence of tumour and neovascular glaucoma, underwent preenucleation radiation with external beam radiation therapy (EBRT) and the eye was lost following enucleation. Among five patients three underwent enucleation and thereafter were referred to surgical oncology for enlarged regional and cervical chain of lymph nodes for suspected metastasis. Histopathology via fine needle aspiration cytology (FNAC) or biopsy from whole specimen showed two cases of spindle cell, one of mixed cell variety and two of epitheloid cell type. Two cases of eitheloid cell type and one of spindle cell type needed EBRT as there was extraocular extension. All cases with enucleation were adviced an ocular implant. A diligent post treatment follow was maintained to look out for local recurrence and distant metastasis. Conclusion: Hill states have poor accessibility to healthcare. Our study shows existence of choroidal melanoma may be much larger than anticipated and cases could have been missed, hence making the need for dilated fundus examination a requirement and necessity. Histopathology, serology and imaging are much needed tools for diagnosis and staging of disease along with treatment of choroidal melanoma eventually indicating prognosis, survival and mortality. Treatment modalities as brachytherapy and EBRT are more frequently being used, indicating a shift in treatment more towards organ salvaging and preservation so as to maintain best visual function.
| Published in | International Journal of Ophthalmology & Visual Science (Volume 6, Issue 4) |
| DOI | 10.11648/j.ijovs.20210604.19 |
| Page(s) | 231-246 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
Brachytherapy, Choroidal, EBRT, Enucleation, Melanoma, Mortality, PET-scan, Prognosis
| [1] | Scotto J, Fraumeni JF Jr, Lee JA. Melanomas of the eye and other noncutaneous sites: epidemiologic aspects. J Natl Cancer Inst. 1976 Mar; 56 (3): 489-91. doi: 10.1093/jnci/56.3.489. |
| [2] | Singh AD, Turell ME, Topham AK. Uveal melanoma: trends in incidence, treatment, and survival. Ophthalmology. 2011 Sep; 118 (9): 1881-5. doi: 10.1016/j.ophtha.2011.01.040. Epub 2011 Jun 24. PMID: 21704381. |
| [3] | Virgili G, Gatta G, Ciccolallo L, Capocaccia R, Biggeri A et al, EUROCARE Working Group. Incidence of uveal melanoma in Europe. Ophthalmology 2007; 114: 2309–2315. [PubMed] [Google Scholar]. |
| [4] | Biswas J, Krishnakumar S, Shanmugam MP. Uveal melanoma in Asian Indians: A clinicopathological study. Arch Ophthalmol. 2002; 120: 522–3. [PubMed] [Google Scholar]. |
| [5] | Kashyap S, Venkatesh P, Sen S, Khanduja S, Shrey D, Tinwala S, et al. Clinicopathologic characteristics of choroidal melanoma in a North Indian population: Analysis of 10-year data. Int Ophthalmol. 2014; 34: 235–9. [PubMed] [Google Scholar]. |
| [6] | Dhupper M, Biswas J, Gopal L, Kumar SK, Khetan V. Clinicopathological correlation of choroidal melanoma in Indian population: A study of 113 cases. Oman J Ophthalmol. 2012; 5: 42–5. [PMC free article] [PubMed] [Google Scholar]. |
| [7] | Shields CL, Kaliki S, Arepalli S, Atalay HT, Manjandavida FP, Pieretti G, Shields JA. Uveal melanoma in children and teenagers. Saudi J Ophthalmol. 2013 Jul; 27 (3): 197-201. doi: 10.1016/j.sjopt.2013.06.013. Epub 2013 Jul 5. PMID: 24227986; PMCID: PMC3770213. |
| [8] | Shields CL, Furuta M, Thangappan A, Nagori S, Mashayekhi A, Lally DR et al. Metastasis of uveal melanoma millimeter-by-millimeter in 8033 consecutive eyes. Arch Ophthalmol 2009; 127 (8): 989–998. [PubMed] [Google Scholar]. |
| [9] | Chang AE, Karnell LH, Menck HR. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 1998; 83 (8): 1664–1678. [PubMed] [Google Scholar]. |
| [10] | Shields CL, Kaliki S, Cohen MN, Shields PW, Furuta M, Shields JA. Prognosis of uveal melanoma based on race in 8100 patients: The 2015 Doyne Lecture. Eye (Lond) 2015; 29 (8): 1027–1035. [PMC free article] [PubMed] [Google Scholar]. |
| [11] | Margo CE, Mulla Z, Billiris K. Incidence of surgically treated uveal melanoma by race and ethnicity. Ophthalmology 1998; 105 (6): 1087–1090. [PubMed] [Google Scholar]. |
| [12] | Hu DN, Yu GP, McCormick SA, Schneider S, Finger PT. Population-based incidence of uveal melanoma in various races and ethnic groups. Am J Ophthalmol 2005; 140 (4): 612–617. [PubMed] [Google Scholar]. |
| [13] | Qiu M, Shields CL. Choroidal nevus in the United States adult population: racial disparities and associated factors in the National Health and Nutrition Examination Survey. Ophthalmology 2015; 122 (10): 2071–2083. |
| [14] | Singh AD, Kalyani P, Topham A. Estimating the risk of malignant transformation of a choroidal nevus. Ophthalmology 2005; 112 (10): 1784–1789. |
| [15] | Shields CL, Cater J, Shields JA, Singh AD, Santos MC, Carvalho C. Combination of clinical factors predictive of growth of small choroidal melanocytic tumors. Arch Ophthalmol 2000; 118 (3): 360–364. |
| [16] | Diener-West M, Reynolds SM, Agugliaro DJ, Caldwell R, Cumming K, Earlees JD et al. Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group Report No. 26. Arch Ophthalmol 2005; 123: 1639–1643. |
| [17] | Kujala E, Mäkitie T, KiveläT. Very long-term prognosis of patients with malignant uveal melanoma. Invest Ophthalmol Vis Sci 2003; 44 (11): 4651–4659. |
| [18] | Raivio I. Uveal melanoma in Finland: an epidemiological, clinical, histological, and prognostic study. Acta Ophthalmol Suppl (Copenh) 1977; 133: 1–64 |
| [19] | Jensen OA. Malignant melanomas of the uvea in Denmark 1943–1952: a clinical, histopathologic, and prognostic study. Acta Ophthalmol Suppl (Copenh) 1963; 75: 17–78. |
| [20] | Kashyap S, Venkatesh P, Sen S, Khanduja S, Shrey D, Tinwala S, Garg S. Clinicopathologic characteristics of choroidal melanoma in a North Indian population: analysis of 10-year data. Int Ophthalmol. 2014 Apr; 34 (2): 235-9. doi: 10.1007/s10792-013-9821-8. Epub 2013 Jul 4. PMID: 23824661. |
| [21] | Manchegowda P, Singh AD, Shields C, Kaliki S, Shah P, Gopal L, Rishi P. Uveal Melanoma in Asians: A Review. Ocul Oncol Pathol. 2021 Jun; 7 (3): 159-167. doi: 10.1159/000512738. Epub 2021 Feb 9. PMID: 34307326; PMCID: PMC8280446. |
| [22] | Shields CL, Shields JA, Milite J, De Potter P, Sabbagh R, Menduke H. Uveal melanoma in teenagers and children. A report of 40 cases. Ophthalmology. 1991 Nov; 98 (11): 1662-6. doi: 10.1016/s0161-6420(91)32071-2. PMID: 1800926. |
| [23] | COMS report No.9 (1998). Randomized trial of pre-enucleation radiation of large choroidal melanoma. I: Characteristics of patients enrolled and not enrolled. Am J Ophthalmol; 125: 767–778. |
| [24] | Mork T. Malignant neoplasms of the eye in Norway: incidence, treatment and prognosis. Acta Ophthalmol 1961; 39: 824–31. |
| [25] | Seddon JS, Egan KM. Application of epidemiologic methods to ophthalmology: uveal melanoma. In: Albert DJ, editor. The principles and practice of ophthalmology. Philadelphia: WB Saunders; 1993; 106: p. 1245–66. |
| [26] | Hakulinen T, Teppop L, Saxen E. Cancer of the eye, a review of trends and differentials. World Health Stat Q 1978; 31: 143–58. |
| [27] | Zloto O, Pe’er J, Frenkel S. Gender differences in clinical presentation and prognosis of uveal melanoma. Invest Ophthalmol Vis Sci. 2013; 54: 652–6. [PubMed] [Google Scholar]. |
| [28] | Rietschel P, Panageas KS, Hanlon C, Patel A, Abramson DH, Chapman PB. Variates of survival in metastatic uveal melanoma. J Clin Oncol. 2005; 23: 8076–80. [PubMed] [Google Scholar]. |
| [29] | Holly EA, Aston DA, Ahn DK, Kristiansen JJ, Char DH. Uveal melanoma, hormonal and reproductive factors in women. Cancer Res. 1991; 51: 1370–2. [PubMed] [Google Scholar]. |
| [30] | Damato EM, Damato BE. Detection and time to treatment of uveal melanoma in the United Kingdom: an evaluation of 2,384 patients. Ophthalmology. 2012 Aug; 119 (8): 1582-9. doi: 10.1016/j.ophtha.2012.01.048. Epub 2012 Apr 11. PMID: 22503229. |
| [31] | Eskelin S, Kivelä T. Mode of presentation and time to treatment of uveal melanoma in Finland. Br J Ophthalmol. 2002 Mar; 86 (3): 333-8. doi: 10.1136/bjo.86.3.333. PMID: 11864894; PMCID: PMC1771030. |
| [32] | Jovanovic P, Mihajlovic M, Djordjevic-Jocic J, Vlajkovic S, Cekic S, Stefanovic V. Ocular melanoma: an overview of the current status. Int J Clin Exp Pathol. 2013 Jun 15; 6 (7): 1230-44. PMID: 23826405; PMCID: PMC3693189. |
| [33] | Shields CL, Furuta M, Berman EL, Zahler JD, Hoberman DM, Dinh DH, Mashayekhi A, Shields JA. Choroidal nevus transformation into melanoma: analysis of 2514 consecutive cases. Arch Ophthalmol. 2009 Aug; 127 (8): 981-7. doi: 10.1001/archophthalmol.2009.151. PMID: 19667334. |
| [34] | Albert DM. Principles and Practice of Ophthalmology. In: Albert, Jakobiec, editors. Philadelphia, PA: W. B. Saunders Co; 1994. pp. 3197–8. Ch. 258. [Google Scholar]. |
| [35] | Kath R, Hayungs J, Bornfeld N, Sauerwein W, Höffken K, Seeber S. Prognosis and treatment of disseminated uveal melanoma. Cancer. 1993 Oct 1; 72 (7): 2219-23. doi: 10.1002/1097-0142(19931001)72:7<2219: aid-cncr2820720725>3.0.co; 2-j. PMID: 7848381. |
| [36] | Shields CL, Manalac J, Das C, Ferguson K, Shields JA. Choroidal melanoma: clinical features, classification, and top 10 pseudomelanomas. Curr Opin Ophthalmol. 2014 May; 25 (3): 177-85. doi: 10.1097/ICU.0000000000000041. PMID: 24614143. |
| [37] | Shields CL, Kaliki S, Rojanaporn D, Ferenczy SR, Shields JA. Enhanced depth imaging optical coherence tomography of small choroidal melanoma: comparison with choroidal nevus. Arch Ophthalmol. 2012 Jul; 130 (7): 850-6. doi: 10.1001/archophthalmol.2012.1135. PMID: 22776921. |
| [38] | Torres VL, Brugnoni N, Kaiser PK, Singh AD. Optical coherence tomography enhanced depth imaging of choroidal tumors. Am J Ophthalmol. 2011 Apr; 151 (4): 586-593.e2. doi: 10.1016/j.ajo.2010.09.028. Epub 2011 Jan 22. PMID: 21257150. |
| [39] | Char DH, Stone RD, Irvine AR, Crawford JB, Hilton GF, Lonn LI, Schwartz A. Diagnostic modalities in choroidal melanoma. Am J Ophthalmol. 1980 Feb; 89 (2): 223-30. doi: 10.1016/0002-9394(80)90115-4. PMID: 7355976. |
| [40] | Gass JD. Problems in the differential diagnosis of choroidal nevi and malignant melanoma. XXXIII Edward Jackson Memorial lecture. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977 Jan-Feb; 83 (1): 19-48. PMID: 898474. |
| [41] | Gass JD. Observation of suspected choroidal and ciliary body melanomas for evidence of growth prior to enucleation. Ophthalmology. 1980 Jun; 87 (6): 523-8. doi: 10.1016/s0161-6420(80)35200-7. PMID: 7413141. |
| [42] | Wang ZY, Yang WL, Li DJ, Chen W, Zhao Q, Li YF, Cui R, Shen L, Wei WB. [Ultrasound diagnosis and differential diagnosis of medium and small choroidal melanomas]. Zhonghua Yan Ke Za Zhi. 2018 Nov 11; 54 (11): 843-848. Chinese. doi: 10.3760/cma.j.issn.0412-4081.2018.11.009. PMID: 30440156. |
| [43] | Sobottka B, Schlote T, Krumpaszky HG, Kreissig I. Choroidal metastases and choroidal melanomas: comparison of ultrasonographic findings. Br J Ophthalmol. 1998 Feb; 82 (2): 159-61. doi: 10.1136/bjo.82.2.159. PMID: 9613382; PMCID: PMC1722472. |
| [44] | Romanowska-Dixon B, Jakubowska B, Markiewicz A, Pawlikowski R. Zastosowanie ultrasonografii w diagnostyce zewnatrzgałkowych nacieków czerniaka błony naczyniowej [Ultrasound techniques in diagnosis of extrabulbar extension of uveal melanoma]. Klin Oczna. 2013; 115 (3): 204-7. Polish. PMID: 24741924. |
| [45] | Papayiannis V, Tsaousis KT, Kouskouras CA, Haritanti A, Diakonis VF, Tsinopoulos IT. Investigation into the quantitative and qualitative characteristics of choroidal melanoma through magnetic resonance imaging and B-scan ultrasound. Clin Ophthalmol. 2017 Aug 22; 11: 1557-1564. doi: 10.2147/OPTH.S130009. PMID: 28860706; PMCID: PMC5573043. |
| [46] | Tailor TD, Gupta D, Dalley RW, Keene CD, Anzai Y. Orbital neoplasms in adults: clinical, radiologic, and pathologic review. Radiographics. 2013 Oct; 33 (6): 1739-58. doi: 10.1148/rg.336135502. PMID: 24108560. |
| [47] | Fielding J A. (2001). The eye and orbit. In: Meire H, Cosgrove D, Dewbury K, Farrant P. Clinical ultrasound, a comprehensive text, abdominal and general ultrasound. Vol 2, 2nd ed. Churchill Livingstone: London; p. 676-680. |
| [48] | Sobottka B, Kreissig I. Ultrasonography of metastases and melanomas of the choroid. Curr Opin Ophthalmol. 1999; 10: 164–7. |
| [49] | Verbeek AM. Differential diagnosis of intraocular neoplasms with ultrasonography. Ultrasound Med Biol. 1985; 11: 163–70. [PubMed] [Google Scholar]. |
| [50] | Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE. Survey of 520 eyes with uveal metastases. Ophthalmology. 1997 Aug; 104 (8): 1265-76. doi: 10.1016/s0161-6420(97)30148-1. PMID: 9261313. |
| [51] | Ward SD, Byrne BJ, Kincaid MC, Mann ES. Ultrasonographic evidence of a mushroom-shaped choroidal metastasis. Am J Ophthalmol. 2000 Nov; 130 (5): 681-2. doi: 10.1016/s0002-9394(00)00604-8. PMID: 11078856. |
| [52] | Finger PT, Kurli M, Reddy S, Tena LB, Pavlick AC. Whole body PET/CT for initial staging of choroidal melanoma. Br J Ophthalmol. 2005 Oct; 89 (10): 1270-4. doi: 10.1136/bjo.2005.069823. PMID: 16170114; PMCID: PMC1772897. |
| [53] | Kurli M, Reddy S, Tena LB, Pavlick AC, Finger PT. Whole body positron emission tomography/computed tomography staging of metastatic choroidal melanoma. Am J Ophthalmol. 2005 Aug; 140 (2): 193-9. doi: 10.1016/j.ajo.2005.02.051. PMID: 15992753. |
| [54] | Reddy S, Kurli M, Tena LB, Finger PT. PET/CT imaging: detection of choroidal melanoma. Br J Ophthalmol. 2005 Oct; 89 (10): 1265-9. doi: 10.1136/bjo.2005.066399. PMID: 16170113; PMCID: PMC1772884. |
| [55] | Histopathologic characteristics of uveal melanomas in eyes enucleated from the Collaborative Ocular Melanoma Study. COMS report no. 6. Am J Ophthalmol. 1998 Jun; 125 (6): 745-66. doi: 10.1016/s0002-9394(98)00040-3. PMID: 9645714. |
| [56] | Shields CL, Shields JA. Recent developments in the management of choroidal melanoma. Curr Opin Ophthalmol. 2004 Jun; 15 (3): 244-51. doi: 10.1097/01.icu.0000120713.35941.e4. PMID: 15118513. |
| [57] | Rusňák Š, Hecová L, Kasl Z, Sobotová M, Hauer L. Therapy of uveal melanoma A Review. Cesk Slov Oftalmol. 2020 Fall; 77 (1): 1-13. English. doi: 10.31348/2020/10. PMID: 33086849. |
| [58] | Melia BM, Abramson DH, Albert DM, Boldt HC, Earle JD, Hanson WF, Montague P, Moy CS, Schachat AP, Simpson ER, Straatsma BR, Vine AK, Weingeist TA; Collaborative Ocular Melanoma Study Group. Collaborative ocular melanoma study (COMS) randomized trial of I-125 brachytherapy for medium choroidal melanoma. I. Visual acuity after 3 years COMS report no. 16. Ophthalmology. 2001 Feb; 108 (2): 348-66. doi: 10.1016/s0161-6420(00)00526-1. PMID: 11158813. |
| [59] | Ghassemi F, Sheibani S, Arjmand M, Poorbaygi H, Kouhestani E, Sabour S, Samiei F, Beiki-Ardakani A, Jabarvand M, Sadeghi Tari A. Comparison of Iodide-125 and Ruthenium-106 Brachytherapy in the Treatment of Choroidal Melanomas. Clin Ophthalmol. 2020 Feb 4; 14: 339-346. doi: 10.2147/OPTH.S235265. PMID: 32099319; PMCID: PMC7007774. |
| [60] | Gündüz K, Shields CL, Shields JA, Cater J, Freire JE, Brady LW. Radiation complications and tumor control after plaque radiotherapy of choroidal melanoma with macular involvement. Am J Ophthalmol. 1999 May; 127 (5): 579-89. doi: 10.1016/s0002-9394(98)00445-0. PMID: 10334352. |
| [61] | Boldt HC, Melia BM, Liu JC, Reynolds SM; Collaborative Ocular Melanoma Study Group. I-125 brachytherapy for choroidal melanoma photographic and angiographic abnormalities: the Collaborative Ocular Melanoma Study: COMS Report No. 30. Ophthalmology. 2009 Jan; 116 (1): 106-115.e1. doi: 10.1016/j.ophtha.2008.10.013. PMID: 19118701; PMCID: PMC3202984. |
| [62] | Jampol LM, Moy CS, Murray TG, Reynolds SM, Albert DM, Schachat AP, Diddie KR, Engstrom RE Jr, Finger PT, Hovland KR, Joffe L, Olsen KR, Wells CG; COMS Follow-up of Plaqued Eyes Working Group. The COMS Randomized Trial of Iodine 125 Brachytherapy for Choroidal Melanoma: IV. Local Treatment Failure and Enucleation in the First 5 Years after Brachytherapy. COMS Report No. 19. Ophthalmology. 2020 Apr; 127 (4S): S148-S157. doi: 10.1016/j.ophtha.2020.01.032. PMID: 32200815. |
| [63] | Damato B, Kacperek A, Chopra M, Campbell IR, Errington RD. Proton beam radiotherapy of choroidal melanoma: the Liverpool-Clatterbridge experience. Int J Radiat Oncol Biol Phys. 2005 Aug 1; 62 (5): 1405-11. doi: 10.1016/j.ijrobp.2005.01.016. PMID: 16029800. |
| [64] | Abrams MJ, Gagne NL, Melhus CS, Mignano JE. Brachytherapy vs. external beam radiotherapy for choroidal melanoma: Survival and patterns-of-care analyses. Brachytherapy. 2016 Mar-Apr; 15 (2): 216-23. doi: 10.1016/j.brachy.2015.12.001. Epub 2016 Feb 1. PMID: 26846381. |
| [65] | Margo CE. The Collaborative Ocular Melanoma Study: an overview. Cancer Control. 2004 Sep-Oct; 11 (5): 304-9. doi: 10.1177/107327480401100504. PMID: 15377989. |
| [66] | Singh AD, Shields CL, Shields JA. Prognostic factors in uveal melanoma. Melanoma Res. 2001 Jun; 11 (3): 255-63. doi: 10.1097/00008390-200106000-00007. PMID: 11468514. |
| [67] | Kaliki S, Shields CL, Shields JA. Uveal melanoma: estimating prognosis. Indian J Ophthalmol. 2015 Feb; 63 (2): 93-102. doi: 10.4103/0301-4738.154367. PMID: 25827538; PMCID: PMC4399142. |
| [68] | Diener-West M, Hawkins BS, Markowitz JA, Schachat AP. A review of mortality from choroidal melanoma. II. A meta-analysis of 5-year mortality rates following enucleation, 1966 through 1988. Arch Ophthalmol. 1992 Feb; 110 (2): 245-50. doi: 10.1001/archopht.1992.01080140101036. PMID: 1531290. |
| [69] | Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol. 2006 Dec; 124 (12): 1684-93. doi: 10.1001/archopht.124.12.1684. PMID: 17159027. |
| [70] | The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma II: initial mortality findings. COMS report no. 10. Am J Ophthalmol. 1998 Jun; 125 (6): 779-96. doi: 10.1016/s0002-9394(98)00039-7. PMID: 9645716. |
| [71] | Hawkins BS; Collaborative Ocular Melanoma Study Group. The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma: IV. Ten-year mortality findings and prognostic factors. COMS report number 24. Am J Ophthalmol. 2004 Dec; 138 (6): 936-51. doi: 10.1016/j.ajo.2004.07.006. PMID: 15629284. |
| [72] | McLean IW, Foster WD, Zimmerman LE, Gamel JW. Modifications of Callender's classification of uveal melanoma at the Armed Forces Institute of Pathology. Am J Ophthalmol. 1983 Oct; 96 (4): 502-9. doi: 10.1016/s0002-9394(14)77914-0. PMID: 6624832. |
| [73] | Paul EV, Parnell BI, Fraker M. Prognosis of malignant melanomas of the choroid and ciliary body. Int Ophthalmol Clin. 1962; 2: 387–402. [Google Scholar]. |
| [74] | McLean IW, Foster WD, Zimmerman LE. Uveal melanoma: location, size, cell type, and enucleation as risk factors in metastasis. Hum Pathol. 1982 Feb; 13 (2): 123-32. doi: 10.1016/s0046-8177(82)80116-0. PMID: 7076200. |
| [75] | Seddon JM, Albert DM, Lavin PT, Robinson N. A prognostic factor study of disease-free interval and survival following enucleation for uveal melanoma. Arch Ophthalmol. 1983 Dec; 101 (12): 1894-9. doi: 10.1001/archopht.1983.01040020896012. PMID: 6651594. |
| [76] | Coupland SE, Campbell I, Damato B. Routes of extraocular extension of uveal melanoma: risk factors and influence on survival probability. Ophthalmology. 2008 Oct; 115 (10): 1778-85. doi: 10.1016/j.ophtha.2008.04.025. Epub 2008 Jun 13. PMID: 18554722. |
| [77] | Seregard S, Kock E. Prognostic indicators following enucleation for posterior uveal melanoma. A multivariate analysis of long-term survival with minimized loss to follow-up. Acta Ophthalmol Scand. 1995 Aug; 73 (4): 340-4. doi: 10.1111/j.1600-0420.1995.tb00039.x. PMID: 8646581. |
| [78] | Seddon JM, Polivogianis L, Hsieh CC, Albert DM, Gamel JW, Gragoudas ES. Death from uveal melanoma. Number of epithelioid cells and inverse SD of nucleolar area as prognostic factors. Arch Ophthalmol. 1987 Jun; 105 (6): 801-6. doi: 10.1001/archopht.1987.01060060087039. PMID: 3579712. |
| [79] | Gamel JW, McLean IW, Foster WD, Zimmerman LE. Uveal melanomas: correlation of cytologic features with prognosis. Cancer. 1978 May; 41 (5): 1897-901. doi: 10.1002/1097-0142(197805)41:5<1897: aid-cncr2820410534>3.0.co; 2-2. PMID: 647633. |
| [80] | Scholes AG, Damato BE, Nunn J, Hiscott P, Grierson I, Field JK. Monosomy 3 in uveal melanoma: Correlation with clinical and histologic predictors of survival. Invest Ophthalmol Vis Sci. 2003; 44: 1008–11. [PubMed] [Google Scholar]. |
| [81] | Tschentscher F, Hüsing J, Hölter T, Kruse E, Dresen IG, Jöckel KH, et al. Tumor classification based on gene expression profiling shows that uveal melanomas with and without monosomy 3 represent two distinct entities. Cancer Res. 2003; 63: 2578–84. [PubMed] [Google Scholar]. |
| [82] | Onken MD, Worley LA, Ehlers JP, Harbour JW. Gene expression profiling in uveal melanoma reveals two molecular classes and predicts metastatic death. Cancer Res. 2004; 64: 7205–9. [PMC free article] [PubMed] [Google Scholar]. |
| [83] | Affeldt JC, Minckler DS, Azen SP, Yeh L. Prognosis in uveal melanoma with extrascleral extension. Arch Ophthalmol. 1980 Nov; 98 (11): 1975-9. doi: 10.1001/archopht.1980.01020040827006. PMID: 7436829. |
| [84] | Pach JM, Robertson DM, Taney BS, Martin JA, Campbell RJ, O'Brien PC. Prognostic factors in choroidal and ciliary body melanomas with extrascleral extension. Am J Ophthalmol. 1986 Mar 15; 101 (3): 325-31. doi: 10.1016/0002-9394(86)90828-7. PMID: 3953727. |
| [85] | Gündüz K, Shields CL, Shields JA, Cater J, Brady L. Plaque radiotherapy for management of ciliary body and choroidal melanoma with extraocular extension. Am J Ophthalmol. 2000 Jul; 130 (1): 97-102. doi: 10.1016/s0002-9394(00)00385-8. PMID: 11004266. |
| [86] | Edge SB, Fritz AG, Byrd DR, Greene FL, Trotti A III, Compton CC, editors. 7th ed. New York: Springer; 2010. AJCC Cancer Staging Manual; pp. 547–59. [Google Scholar]. |
| [87] | Shields CL, Kaliki S, Furuta M, Fulco E, Alarcon C, Shields JA. American Joint Committee on Cancer classification of posterior uveal melanoma (tumor size category) predicts prognosis in 7731 patients. Ophthalmology. 2013 Oct; 120 (10): 2066-71. doi: 10.1016/j.ophtha.2013.03.012. Ep88. |
| [88] | Bedikian AY, Kantarjian H, Young SE, Bodey GP. Prognosis in metastatic choroidal melanoma. South Med J. 1981 May; 74 (5): 574-7. doi: 10.1097/00007611-198105000-00017. PMID: 7244714. |
| [89] | Factors predictive of growth and treatment of small choroidal melanoma: COMS Report No. 5. The Collaborative Ocular Melanoma Study Group. Arch Ophthalmol. 1997 Dec; 115 (12): 1537-44. doi: 10.1001/archopht.1997.01100160707007. PMID: 9400787. |
| [90] | The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma III: local complications and observations following enucleation COMS report no. 11. Am J Ophthalmol. 1998 Sep; 126 (3): 362-72. doi: 10.1016/s0002-9394(98)00091. PMID: 9744369. |
| [91] | Bensoussan E, Thariat J, Maschi C, Delas J, Schouver ED, Hérault J, Baillif S, Caujolle JP. Outcomes After Proton Beam Therapy for Large Choroidal Melanomas in 492 Patients. Am J Ophthalmol. 2016 May; 165: 78-87. doi: 10.1016/j.ajo.2016.02.027. Epub 2016 Mar 3. PMID: 26940166. |
| [92] | Lin AJ, Rao YJ, Acharya S, Schwarz J, Rao PK, Grigsby P. Patterns of care and outcomes of proton and eye plaque brachytherapy for uveal melanoma: Review of the National Cancer Database. Brachytherapy. 2017 Nov-Dec; 16 (6): 1225-1231. doi: 10.1016/j.brachy.2017.07.014. Epub 2017 Sep 28. PMID: 28966081. |
| [93] | Shields CL, Demirci H, Materin MA, Marr BP, Mashayekhi A, Shields JA. Clinical factors in the identification of small choroidal melanoma. Can J Ophthalmol. 2004 Jun; 39 (4): 351-7. doi: 10.1016/s0008-4182(04)80005-x. PMID: 15327099. |
| [94] | Collaborative Ocular Melanoma Study Group.. Assessment of metastatic disease status at death in 435 patients with large choroidal melanoma in the Collaborative Ocular Melanoma Study (COMS): COMS report no. 15. Arch Ophthalmol. 2001 May; 119 (5): 670-6. doi: 10.1001/archopht.119.5.670. PMID: 11346394. |
APA Style
Deepesh Arora, Anuj Sharma, Devesh Sharma, Bhavna Tiwari, Abhishek Kumar, et al. (2021). Prevalence of Choroidal Melanoma in a Hill Population of Northern India. International Journal of Ophthalmology & Visual Science, 6(4), 231-246. https://doi.org/10.11648/j.ijovs.20210604.19
ACS Style
Deepesh Arora; Anuj Sharma; Devesh Sharma; Bhavna Tiwari; Abhishek Kumar, et al. Prevalence of Choroidal Melanoma in a Hill Population of Northern India. Int. J. Ophthalmol. Vis. Sci. 2021, 6(4), 231-246. doi: 10.11648/j.ijovs.20210604.19
AMA Style
Deepesh Arora, Anuj Sharma, Devesh Sharma, Bhavna Tiwari, Abhishek Kumar, et al. Prevalence of Choroidal Melanoma in a Hill Population of Northern India. Int J Ophthalmol Vis Sci. 2021;6(4):231-246. doi: 10.11648/j.ijovs.20210604.19
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijovs.20210604.19,
author = {Deepesh Arora and Anuj Sharma and Devesh Sharma and Bhavna Tiwari and Abhishek Kumar and Kanika Gupta and Rohan Mehra and Abhinav Arora and Dinesh Sharma},
title = {Prevalence of Choroidal Melanoma in a Hill Population of Northern India},
journal = {International Journal of Ophthalmology & Visual Science},
volume = {6},
number = {4},
pages = {231-246},
doi = {10.11648/j.ijovs.20210604.19},
url = {https://doi.org/10.11648/j.ijovs.20210604.19},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20210604.19},
abstract = {Aim: To assess prevalence and presentation of choroidal melanoma in a hill population of northern India along with its demographics, features, diagnostics, treatment and outcome with comparison to western population. Method: Choroidal melanoma constitutes most common intraocular malignancy with early appearance in Asian population. This is the 1st case series from a hill state of Uttarakhand, northern India involving medium to large size tumour with extraocular extension. In this retrospective study we assessed the prevalence, clinical presentation, diagnostic modalities, treatment plan, disease outcome, prognosis with survival and mortality. The study was carried out in time duration from February 2019- March 2021. Results: Data shows the presence of five patients, four male and 1 female in age range of 47-77 years, with median age at 62 years. Patient presented with visual equity in range of 6/18 to perception of light in time range of six months to 2 years. Fundus examination revealed presence of medium to large size choroidal mass with surface pigmentation and serous detachment. Neovascular glaucoma was present in three patients. Three patients underwent brachytherapy with I 125 and Ru 106, two cases responded well to therapy, one case presented with recurrence of tumour and neovascular glaucoma, underwent preenucleation radiation with external beam radiation therapy (EBRT) and the eye was lost following enucleation. Among five patients three underwent enucleation and thereafter were referred to surgical oncology for enlarged regional and cervical chain of lymph nodes for suspected metastasis. Histopathology via fine needle aspiration cytology (FNAC) or biopsy from whole specimen showed two cases of spindle cell, one of mixed cell variety and two of epitheloid cell type. Two cases of eitheloid cell type and one of spindle cell type needed EBRT as there was extraocular extension. All cases with enucleation were adviced an ocular implant. A diligent post treatment follow was maintained to look out for local recurrence and distant metastasis. Conclusion: Hill states have poor accessibility to healthcare. Our study shows existence of choroidal melanoma may be much larger than anticipated and cases could have been missed, hence making the need for dilated fundus examination a requirement and necessity. Histopathology, serology and imaging are much needed tools for diagnosis and staging of disease along with treatment of choroidal melanoma eventually indicating prognosis, survival and mortality. Treatment modalities as brachytherapy and EBRT are more frequently being used, indicating a shift in treatment more towards organ salvaging and preservation so as to maintain best visual function.},
year = {2021}
}
TY - JOUR T1 - Prevalence of Choroidal Melanoma in a Hill Population of Northern India AU - Deepesh Arora AU - Anuj Sharma AU - Devesh Sharma AU - Bhavna Tiwari AU - Abhishek Kumar AU - Kanika Gupta AU - Rohan Mehra AU - Abhinav Arora AU - Dinesh Sharma Y1 - 2021/12/09 PY - 2021 N1 - https://doi.org/10.11648/j.ijovs.20210604.19 DO - 10.11648/j.ijovs.20210604.19 T2 - International Journal of Ophthalmology & Visual Science JF - International Journal of Ophthalmology & Visual Science JO - International Journal of Ophthalmology & Visual Science SP - 231 EP - 246 PB - Science Publishing Group SN - 2637-3858 UR - https://doi.org/10.11648/j.ijovs.20210604.19 AB - Aim: To assess prevalence and presentation of choroidal melanoma in a hill population of northern India along with its demographics, features, diagnostics, treatment and outcome with comparison to western population. Method: Choroidal melanoma constitutes most common intraocular malignancy with early appearance in Asian population. This is the 1st case series from a hill state of Uttarakhand, northern India involving medium to large size tumour with extraocular extension. In this retrospective study we assessed the prevalence, clinical presentation, diagnostic modalities, treatment plan, disease outcome, prognosis with survival and mortality. The study was carried out in time duration from February 2019- March 2021. Results: Data shows the presence of five patients, four male and 1 female in age range of 47-77 years, with median age at 62 years. Patient presented with visual equity in range of 6/18 to perception of light in time range of six months to 2 years. Fundus examination revealed presence of medium to large size choroidal mass with surface pigmentation and serous detachment. Neovascular glaucoma was present in three patients. Three patients underwent brachytherapy with I 125 and Ru 106, two cases responded well to therapy, one case presented with recurrence of tumour and neovascular glaucoma, underwent preenucleation radiation with external beam radiation therapy (EBRT) and the eye was lost following enucleation. Among five patients three underwent enucleation and thereafter were referred to surgical oncology for enlarged regional and cervical chain of lymph nodes for suspected metastasis. Histopathology via fine needle aspiration cytology (FNAC) or biopsy from whole specimen showed two cases of spindle cell, one of mixed cell variety and two of epitheloid cell type. Two cases of eitheloid cell type and one of spindle cell type needed EBRT as there was extraocular extension. All cases with enucleation were adviced an ocular implant. A diligent post treatment follow was maintained to look out for local recurrence and distant metastasis. Conclusion: Hill states have poor accessibility to healthcare. Our study shows existence of choroidal melanoma may be much larger than anticipated and cases could have been missed, hence making the need for dilated fundus examination a requirement and necessity. Histopathology, serology and imaging are much needed tools for diagnosis and staging of disease along with treatment of choroidal melanoma eventually indicating prognosis, survival and mortality. Treatment modalities as brachytherapy and EBRT are more frequently being used, indicating a shift in treatment more towards organ salvaging and preservation so as to maintain best visual function. VL - 6 IS - 4 ER -
Information
Email: