MALIGNANT MELANOMA

Dr Rajvin Samuel

Malignant melanoma

otherwise called Melanocarcinoma

It is a cancerous condition arising from melanocytes.

SITES OF OCCURENCE

Eyelids

Conjunctiva

Uvea [iris ,Ciliary body, Choroid]

EYELIDS Invasive proliferation of intraepidermal

melanocytes

Risk Factors : 1.Congenital,dysplastic nevi 2.Changing cutaneous moles 3.Excessive sun exposure 4.Family history 5.Caucasian race

OCULAR MANIFESTATIONS:

Lentigo maligna melanoma[flat macule]

Superficial spreading [elevated slightly]

Nodular melanoma[ size , ulcer , bleed]

Diagnosis : - Excisional biopsy

Treatment : It is a radio resistant. - Wide surgical excision[Histo monitor] - Regional lymph node dissection

CONJUNCTIVA

Raised pigmented /non pigmented lesion of substantia propria

Limbal/perilimbal conjunctiva [nasal/temporal]

–interpalpebral fissure

Originate from basal layers of epithelium

Associated with preexisting nevus or de novo

Contains numerous prominent blood vessels

Invades blood vessels,lymphatic vessels,

cornea , sclera.

Increased size,solidity, fixation to underlying

sclera - suspect malignant melanoma

TNM STAGING [CONJUNCTIVAL MELANOMA]

TX - Primary tumor cannot be assessed TO - No evidence of primary tumor T1 - Tumor(s) of bulbar conjunctiva

occupying 1 quadrant or less T2 - Tumor(s) of bulbar conjunctiva

occupying more than 1 quadrant T3 - Tumor(s) of conjunctival fornix

and/or palpebral conjunctiva and/or caruncle

T4 - Tumor invades eyelid, cornea, and/or orbit

Nx – Regional lymph node not assessed No - No regional lymph node metastasis N1 - Metastasis in only one lymph node N2 - Metastasis in 2 or more regional

lymph nodes with intralymphatic vessel

metastasis N3 – Nodal metastasis

Mx – Distant metastasis not assessed Mo - No distant metastasis M1 - Distant metastasis

Treatment: - Complete excision with cryotherapy - Contact radiation therapy - exenteration

UVEAL MELANOMA

Malignant neoplasm arises from

neuroectodermal melanocytes in

choroid,ciliary body/iris

IRIS MELANOMA Ocular manifestations

Visible spot /discolouration of iris – one eye size, apparent cohesiveness, intrinsic vascularity IOP , Pupillary peaking , ectropion iridis , iris splinting

DIAGNOSIS : Transpupillary /transconjunctival trans-

scleral illumination

Anterior segment photography /Goniophtography

Fluorescein angiography

Ultrasound biomicroscopy

Incisional biopsy & fine needle aspiration biopsy

TREATMENT

Observation

Excision- [iridectomy/iridocyclectomy]

Plaque radiotherapy

Enucleation

CHOROIDAL & CILIARY BODY MELANOMA Ocular manifestations:

blurry vision, visual field defects, floaters,flashes

Ciliary body melanoma : Trans scleral extension – pigmented

epibulbar nodule – peripheral fundus Dilated blood vessels

CHOROIDAL MELANOMA : Dark brown golden ,

biconvex lenitcular /dome mushroom shape

Orange patches appear in RPE due to lipofuscin accumulation

Associated with non rhegmatogenous retinal detachment - Clear serous shifting sub retinal fluid

DIAGNOSIS B-SCAN A SCAN [High to low amplitude internal reflectivity – echoes] Fluorescein angiography -[RPE involvement ,vascular leakage, SR

fluid] Indocyanine angiography - [Hypofluorescent mass] CT MRI [ hyperintensity relative to vitreous]

TREATMENT Enucleation Radiation therapy Observation Microsurgical resection - External trans scleral resection - Transvitreal endo resection Laser therapy - Transpupillary thermotherapy [diode infrared laser] Exenteration

THANK YOU