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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