Changing concept in the management of choroidal melanoma

Purpoe To review emerging information related to changing concept in the management of choroidal melanoma. Deign and method Thi perpective review and dicue elected tudie from the pat two decade that have influenced management trategie for large, medium, and mall-ize choroidal melanoma. Reult Large choroidal tumor continue to be managed primarily by enucleation. The large tumor trial of the Collaborative Ocular Melanoma tudy (COM) demontrated neither a poitive nor negative effect on 5- and 8-year mortality rate among more than 1,000 patient whoe eye containing large choroidal melanoma were randomized to treatment between enucleation alone or enucleation preceded by external radiation. The medium-ize tumor trial of the COM randomized more than 1,300 patient between iodine-125 brachytherapy and enucleation. Mortality rate following brachytherapy did not differ from mortality rate following enucleation for up to 12 year after treatment. Iodine-125 ha become the mot commonly ued iotope for brachytherapy in North America. Ten-year follow-up of eye treated with helium ion and 20 year of experience with proton beam confirm the relative afety and efficacy of thee modalitie for treatment of choroidal melanoma. Although there i a trend toward earlier treatment of mall melanoma, controvery exit regarding the indication for treatment a well a the choice of pecific therapy. Recurrence of melanoma after eye-paring treatment appear to be aociated with an increaed rate of metatatic dieae. Effective adjunctive therapy to prevent or treat melanoma metatai i lacking. Concluion Choroidal melanoma i a lethal tumor. Although evidence ugget that patient with untreated choroidal melanoma have a poorer prognoi than patient who receive treatment, our current treatment are unable to prevent tumor-related death for many patient. The ue of preoperative external radiation a an adjunct to enucleation for large choroidal melanoma i unupported by data from the COM trial. The ue of radiation with either brachytherapy or charged particle for the management of medium-ize choroidal melanoma i well upported on the bai of long-term follow-up tudie. There i a trend toward treatment of maller choroidal melanoma. Treatment of melanoma hould be directed toward minimizing the potential for recurrence a recurrent melanoma are aociated with an increaed rate of metatatic dieae. Gain in our ability to manage choroidal melanoma will likely be modet at bet until effective ytemic therapie can be identified.