Management and Outcome of Uveal Melanoma in a Single Tertiary Cancer Center in Jordan

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Abstract

Objective: The aim of this study was evaluate the features and outcome of management of uveal melanoma in King Hussein Cancer Center as an example of a referral tertiary cancer center in the Middle East.

Material and Method: This was aetrospective, observational case series of 46 eyes of 46 patients with uveal melanoma. Data collection required access to medical records, radiology and pathology reports, and laboratory results. The main outcome measures included age at diagnosis, tumor location and dimensions, TNM stage, treatment modality, visual outcome, metastasis, and mortality.

Results: There was slight female preference, and the median age at diagnosis was 45 years. Eighteen (39%) eyes were treated by primary enucleation, and 28 (61%) eyes were treated by I-125 radioactive plaque. The melanoma was in the choroid in 40 (87%) eyes and in the ciliary body in 6 (13%) eyes, with no single tumor in the iris. According to the 7th edition of the American Joint Committee on Cancer staging system (UICC/AJCC); 8 (17%) were T1, 17 (36%) were T2, 16 (35%) were T3, and 5 (11%) were T4. One (2%) patient showed lymph node metastasis (N1), and 6 (13%) patients showed distant metastasis (M1). Pathologically, 2 (10%) of the enucleated eyes were spindle cell type, 4 (20%) were epithelioid cell type, and 14 (70%) were mixed type. Extrascleral extension was seen in three (15%) eyes, and optic nerve invasion in two (10%) eyes. After brachytherapy, 26 (93%) eyes were salvaged, and 2 eyes were consecutively enucleated; one for tumor recurrence, and one for uncontrolled painful neovascular glaucoma. The eye salvage rate post plaque was 93% (26/28), and the visual acuity for the salvaged eyes was equal or better than 0.5 in 11 (42%) eyes, 0.1-0.4 in 5 (19%) eyes, and less than 0.1 in 10 (38%) eyes.

Conclusion: The incidence of uveal melanomas in our region is low compared to that in the West with a younger age at presentation. Candidate tumors for radioactive plaque therapy were successfully controlled in 93% of cases.

1. Finger PT. Intraocular melanoma. In: Devita VT, Lawrence TS, Rosenberg SA, editors. Cancer (principles & practice of oncology) Ophthalmology. 10th ed. Philadelphia: LWW; 2011. 1770-9.

2. Shields CL, Kaliki S, Furuta M, Mashayekhi A, Shields JA. Clinical spectrum and prognosis of uveal melanoma based on age at presentation in 8,033 cases. Retina. 2012;32:1363-72.

3. Shields CL, Kaliki S, Shah SU, Luo W, Furuta M, Shields JA. Iris melanoma: Features and prognosis in 317 children and adults. J AAPOS. 2012;16:10-6.

4. Oittinen HA, O’Shaughnessy M, Cullinane AB, Keohane C. Malignant melanoma of the ciliary body presenting as extraocular metastasis in the temporalis muscle. J Clin Pathol. 2007;60:834-5.

5. Kujala E, Makitie T, Kivela T. Very long-term prognosis of patients with malignant uveal melanoma. Invest Ophthalmol Vis Sci. 2003;44:4651-9.

6. Diener-West M, Earle JD, Fine SL, Hawkins BS, Moy CS, Reynolds SM, Schachat AP, Straatsma BR; Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: Initial mortality findings. COMS Report No. 18. Arch Ophthalmol. 2001;119:969-82.

7. Singh AD, Kalyani P, Topham A. Estimating the risk of malignant transformation of a choroidal nevus. Ophthalmology. 2005;112:1748-9.

8. 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;124:1684-93.

9. Singh AD, Kivelä T. The collaborative ocular melanoma study. Ophthalmol Clin North Am. 2005;18:129-42.

10. Accuracy of diagnosis of choroidal melanomas in the Collaborative Ocular Melanoma Study. COMS report no. 1. Arch Ophthalmol. 1990;108:1268-73.

11. Albert DM, Ruzzo MA, McLaughlin MA, Robinson NL, Craft JL, Epstein J. Establishment of cell lines of uveal melanoma. Methodology and characteristics. Invest Ophthalmol Vis Sci. 1984;25:1284-99.

12. The AJCC Ophthalmic Oncology Task Force. Malignant melanoma of the uvea. In: Edge SE, Byrd DR, Carducci MA, Compton CA, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2009. 547-53.

13. Alsuhaibani AH. Uveal melanoma in the Saudi Arabian population: Two decades of management at the King Khaled Eye Specialist Hospital. Saudi J Ophthalmol. 2009;23:157-63.

14. Kuo PK, Puliafito CA, Wang KM, Liu HS, Wu BF. Uveal melanoma in China. Int Ophthalmol Clin. 1982;22:57-71.

15. Manschot WA, van Strik R. Uveal melanoma: Therapeutic consequences of doubling times and irradiation results. A review. Int Ophthalmol. 1992;16:91-9.

16. Bergman L, Seregard S, Nilsson B, Ringborg U, Lundell G, Ragnarsson-Olding B. Incidence of uveal melanoma in Sweden from 1960 to 1998. Invest Ophthalmol Vis Sci. 2002;43:2579-83.

17. Diener-West M, Earle JD, Fine SL, Hawkins BS, Moy CS, Reynolds SM, Schachat AP, Straatsma BR; Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, II: Characteristics of patients enrolled and not enrolled. COMS Report No. 17. Arch Ophthalmol. 2001;119:951-65.

18. McLean IW. Uveal nevi and malignant melanoma. In: Spencer WH, editor. Ophthalmic pathology: An atlas and textbook, 4th ed. Philadelphia: Saunders; 1996. 2121-217.

19. Barr CC, McLean IW, Zimmerman LE. Uveal melanoma in children and adolescents. Arch Ophthalmol. 1981;99:2133-6.

20. Scotto J, Fraumeni JF Jr, Lee JA. Melanomas of the eye and other noncutaneous sites: Epidemiologic aspects. J Natl Cancer Inst. 1976;56:489-91.

21. Phillpotts BA, Sanders RJ, Shields JA, Griffiths JD, Augsburger JA, Shields CL. Uveal melanomas in black patients: A cases series and comparative review. J Natl Med Assoc. 1995;87:709-14.

22. 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;96:502-9.

23. The Collaborative Ocular Melanoma Study Group. Mortality in patients with small choroidal melanoma: COMS Report No. 4. Arch Ophthalmol. 1997;115:886-93.

24. The Collaborative Ocular Melanoma Study (COMS) randomized trial of preenucleation radiation of large choroidal melanoma. II. Initial mortality findings. COMS Report No. 10. Am J Ophthalmol. 1998;125:779-96.

25. Diener-West M, Reynolds SM, Agugliaro DJ, Caldwell R, Cumming K, Earle JD, Green DL, Hawkins BS, Hayman J, Jaiyesimi I, Kirkwood JM, Koh WJ, Robertson DM, Shaw JM, Thoma J; Collaborative Ocular Melanoma Study Group Report 23. Screening for metastasis from choroidal melanoma: The Collaborative Ocular Melanoma Study Group Report No. 23. J Clin Oncol. 2004;22:2438-44.

Turkish Journal of Pathology

The Journal of Federation of Turkish Pathology Societies 

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Cite Score 2018: 0.88

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