Choroidal Melanoma: Causes, Treatment Options, and Prognosis
In the realm of eye health, one condition that warrants careful attention is choroidal melanoma, a type of cancer that develops in the choroid layer of the eye. This article provides an overview of the common treatments for choroidal melanoma, the staging systems used to determine its progression, and the latest developments in precision medicine.
Choroidal melanoma is typically categorised using the TNM system, which takes into account the size and extent of the tumor (T), the spread to nearby lymph nodes (N), and the spread to distant areas, called metastasis (M). Common treatments for choroidal melanoma include radiotherapy, surgical excision, local thermotherapy, and enucleation.
Radiotherapy, such as plaque brachytherapy, is widely used as a globe-sparing treatment to control tumor growth while preserving vision, especially for small to medium tumors. Enucleation (removal of the eye) is generally reserved for large tumors with extensive extraocular spread or when vision cannot be preserved. Local thermotherapy (heat-based treatment) may be used adjunctively. Chemotherapy is typically reserved for advanced metastatic disease but is not a first-line treatment due to limited efficacy.
Recent developments in immunotherapy and molecularly targeted therapies are emerging, particularly in metastatic cases or patients resistant to conventional treatments. These advancements reflect a shift toward precision, individualized care, with examples including adoptive cell therapy, CAR-T cells, and tebentafusp.
Regarding staging systems, the American Joint Committee on Cancer (AJCC) TNM system and the Collaborative Ocular Melanoma Study (COMS) staging system are the most widely used. The COMS system of staging is simpler and based on the size of a person's tumor: small (1-3mm in height and 5-16mm across), medium (3.1 to 8mm in height and no larger than 16mm across), and large (greater than 8mm in height or larger than 16mm across).
Large choroidal melanomas usually involve radiation therapy or surgery. The treatment may include enucleation if the tumor takes up more than half of the eye socket, causes significant pain, or has caused loss of vision.
Early detection is vital for choroidal melanoma, and regular dilated eye exams are important for checking eye health, as choroidal melanoma does not always produce symptoms. The median disease-free survival time for a person with choroidal melanoma is 26 months, but following metastasis to the liver, the median survival time is 8 months.
In conclusion, the mainstays of choroidal melanoma treatment are radiotherapy (plaque brachytherapy) for small to medium tumors, enucleation for large or advanced tumors unamenable to vision preservation, local thermotherapy as adjunct treatment, and systemic therapies (immunotherapy, chemotherapy) mostly for metastatic disease or clinical trials. These treatments are selected based on tumor size, location, patient vision, and metastatic risk, with ongoing research aimed at more personalized and effective options.
- In the world of science, choroidal melanoma, a type of eye cancer, is a condition that requires careful attention, especially in the realm of eye health.
- This article sheds light on the common treatments for choroidal melanoma, including radiotherapy, surgical excision, local thermotherapy, and enucleation.
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