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Terms in this set (16)
Intraocular melanomas arise in...
... the uvea, with more than 90% involving the choroid and the remainder being confined to ciliary body and iris.
Uveal melanomas arise from...
...melanocytes, which are derived from neural crest.
Five risk factors for uveal melanoma include...
...white skin, light-colored eyes, melanocytoma, congenital ocular melanocytosis and neurofibromatosis.
The incidence of uveal melanoma in Caucasians is...
...7 per million per year.
The four most common symptoms are...
...blurred vision, metamorphopsia, photopsia and visual loss.
In the UK, the percentage of patients detected with an asymptomatic uveal melanoma is approximately...
The eight features indicating an intraocular melanoma are...
Melanoma visible externally (e.g., in iris or under conjunctiva);
Eccentric visual phenomena (i.e., field loss, photopsia);
Lens abnormalities (i.e., cataract, astigmatism);
Afferent pupillary defect (non-specific but sensitive);
No optical correction (if the fovea is abnormal);
Ocular hypertension (if tumour or vessels close the angle);
Melanocyt-osis or -oma (which predispose to melanoma);
Asymmetrical episcleral vessels ( =ciliary body tumour).
(Note the acronym - MELANOMA).
Four features distinguishing choroidal melanoma from naevus are:
...thickness exceeding 2 mm; orange pigment; serous retinal detachment overlying the tumour; and lack of drusen over an elevated lesion.
Eight therapeutic modalities for uveal melanoma include:
Plaque radiotherapy (i.e., iodine, ruthenium, palladium);
Proton beam radiotherapy;
The main objectives of ocular treatment are to...
...prevent metastatic spread, if possible conserving the eye and useful vision.
The percentage of patients with uveal melanoma who die of metastatic disease is...
Ten risk factors for metastatic death include...
Large basal tumour diameter;
Ciliary body involvement;
High mitotic count;
Chromosome 3 loss (especially with chromosome 8q gain);
Lack of chromosome 6p gain;
Class 2 gene expression profile.
Metastatic disease from uveal melanoma usually involves...
...the liver, which is affected in about 90% of patients with detectable metastases.
Screening for metastases from uveal melanoma involves...
...some form of liver imaging (e.g., ultrasonography, MRI with or without contrast and diffiusion weighting);
...biochemical liver function tests (which become abnormal only when metastases are advanced);
...chest radiography (if indicated by symptoms; otherwise, the yield of this test is very poor);
...CNS imaging (if indicated by symptoms; otherwise, the yield is poor);
...serum studies (i.e., detecting circulating melanoma cells, still in preparation or under evaluation).
The age at presentation with uveal melanoma peaks at:
around 60 years.
Treatment modalities for metastases from uveal melanoma include:
...intra-hepatic chemotherapy (e.g., using the Delcath system);
...resection of isolated metastases;
...ipilimumab, a form of immunotherapy;
...systemic chemotherapy, which is effective in only a small proportion of patients.
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