A number of known identifiers of poor prognosis for uveal melanoma are available that can determine patients at a high risk for developing metastasis and who may benefit from targeted treatment.
Although uveal melanomas are rare, they are the most common primary malignancy of the eye in adults.1 For most melanomas, approximately 90 percent arise from the choroid and ciliary body. Only about 10 percent arise from the iris (see Figure 1).1
Treatment options depend on numerous factors, including the size and location of the tumor, the patient’s age and overall health, as well as his life expectancy. These tumors generally develop in older individuals.
Prognosis depends on the cell type of the tumor, size, location, the amount of ciliary body involvement, and evidence of extraocular involvement.
Related: How to identify ocular cancer
Regarding cell type, tumors consisting of spindle-A cells have the best prognosis, and epithelioid cell tumors have the worst prognosis.2 There can also be a combination of the two: a “mixed-cell” type.3
Iris melanomas arise from melanocytes of the iris stroma. They tend to occur more frequently in light-skinned individuals with blue irides.3 About 80 percent of iris melanomas are located in the inferior quadrant of the iris. Tumors can present as circumscribed or diffuse, lobular or flat, with variable pigmentation ranging from deeply pigmented to amelanotic.
Secondary findings may include ectropion iridis, secondary glaucoma, cataract, and prominent vasculature. Patients may be asymptomatic or present with large tumors causing vision loss, visual field defects, spontaneous hyphema, corneal edema, and band keratopathy due to corneal compression. Patients presenting with diffuse melanomas often have hyperchromic heterochromia and secondary glaucoma, and these tumors are more likely to produce metastatic disease.4
1. Harbour JW. An update on uveal melanoma. Rev Ophthalmology. Available at: https://www.reviewofophthalmology.com/article/an-update-on-uveal-melanoma. Accessed 2/18/20.
2. Stephenson M. Better options emerging in ocular oncology. Rev Ophthalmology. Available at: https://www.reviewofophthalmology.com/article/better-options-emerging-in.... Accessed 2/18/20.
3. Manhattan Eye, Ear, and Throat Hospital, Department of Ophthalmology. Color Atlas of Ophthalmology: The Manhattan Eye, Ear, and Throat Hospital Pocket Guide. Eds: Mandava S, Sweeney T, Guyer D. Pp. 329-330. New York, New York: Thieme. 1999.
4. Shields JA, Shields C. Tumors of the Uveal Tract. In: Duane’s Atlas of Ophthalmology: Vol. 4 (Tasman W, Jaeger EA, Eds.) Philadelphia: Lippincott Williams & Wilkins. 2009.
5. Lumbroso-Le Rouic L, Charif Chefchaouni M, Levy C, Plancher C, Dendale R, Asselain B, Solignac S, Mazal A, Desjardins L. 125I plaque brachytherapy for anterior uveal