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14 Cards in this Set
- Front
- Back
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The incidence of metastasis is
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50% at 25 years.
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The incidence of detectable metastases at presentation is
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2%.
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Most metastatic disease presents with
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liver involvement, less common sites being lung, bone and skin.
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Clinical predictors include
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large basal diameter, great tumor thickness, ciliary body involvement and extraocular spread.
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Histological predictors include
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epithelioid cells, high mitotic count, extravascular matrix patterns such as closed loops, tumor infiltrating lymphocytes.
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Genetic predictors include
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chromosome 3 deletion, chromosome 8q gain, lack of chromosome 6p gain, class 2 gene expression profile.
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Which patients require metastatic evaluation prior to ocular treatment:
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All according to BCSC but only those with a tumor exceeding 17mm according to BED.
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The objectives of pre-treatment screening are
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to detect unrelated cancer; to detect metastases from uveal melanoma; and to decide whether to treat the primary ocular tumor.
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Screening frequency should be
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yearly according to BCSF but 6 monthly according to most practitioners nowadays.
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Metastatic evaluation should include
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liver imaging (US, CT, MRI, PET-CT); LFTs; and chest x-ray (according to BCSC). MRI only according to BED
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Treatments for liver metastases include
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systemic chemo, intrahepatic chemo, radiotherapy, partial hepatectomy, targeted therapy, immunotherapy.
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The collaborative large choroidal melanoma trial reported that
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pre-enucleation radiotherapy is no better than enucleation alone in preventing metastasis.
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The collaborative medium choroidal melanoma trial reported that
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enucleation is no better than iodine125 brachytherapy in preventing metastasis.
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The collaborative small choroidal melanoma trial reported that features predicting growth are
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greater tumor size at presentation, orange pigment, absence of drusen and pinpoint hyperfluorescence on fluorescein angiography
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