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Large choroidal melanoma

Choroidal melanomas classified as large by the COMS standard are most commonly managed by enucleation. However, radiation therapy (either as monotherapy or adjunct therapy) and local resection may be viable treatment options in some cases.

External-beam radiation therapy (EBRT)

EBRT (charged-particle beams of proton or helium ions) allows for a high dosage of radiation to be delivered to a tumor, regardless of size or proximity to fovea or optic nerve (Box 51.4). At most centers, patients undergo preradiation surgery during which tumor borders are delineated by transillumination and tantalum rings subsequently sutured to the sclera at the tumor borders. EBRT is then administered with the assistance of a sophisticated treatment planning program that utilizes a three-dimensional model of the tumor based on fundus photographs, ultrasound measurements, and location of tantalum rings on roentgenogram.

Box 51.4 

Large choroidal melanoma (Collaborative Ocular Melanoma Study (COMS) definition)

  •    >16 mm in basal diameter
  •    Treatment with pre-enucleation radiotherapy versus enucleation results in similar melanoma-specific mortality (COMS)
  •    Favorable local recurrence rates are achievable with local resection and external-beam radiation therapy (EBRT)

Though its use is limited by the cost and limited availability of …