What is the role of enucleation in the treatment of ciliary body melanoma?

Updated: Mar 03, 2020
  • Author: Enrique Garcia-Valenzuela, MD, PhD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

Multiple modes of treatment are available for ciliary body and other uveal melanomas. In determining an approach, multiple factors need to be considered, such as visual acuity of the affected eye and of the contralateral eye, intraocular pressure, ocular structures involved, size of the tumor, age and general health of the patient, and presence of metastases.

Observation may be acceptable for posterior uveal tumors when diagnosis is not well established. In particular, tumors of less than 2 mm in elevation can be observed until growth is documented. Sequential measurements of the tumor dimensions with ultrasonography are necessary.

Enucleation is the classic approach to posterior ciliary body melanomas. It often has been the preferred treatment of advanced and complicated tumors, which compromise visual function, and when other therapies have failed. Because of the potential release of malignant cells into the bloodstream and orbital soft tissues during the surgical procedure, keep manipulation of the globe to a minimum.

Some physicians advocate for preenucleation radiation therapy to hypothetically reduce local and hematogenous dissemination.

The theoretical advantage of enucleation over vision-sparing treatments is a decreased risk of metastatic spread. It remains unproven, however, whether enucleation truly improves the patient's prognosis for life over vision-sparing techniques.


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