Skip to main content
NCBI home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2001 Jul;85(7):848–854. doi: 10.1136/bjo.85.7.848

Primary iris melanoma: diagnostic features and outcome of conservative surgical treatment

R Conway 1, W Chua 1, C Qureshi 1, F Billson 1
PMCID: PMC1724056  PMID: 11423461

Abstract

AIMS—To describe features influencing the management of primary iris melanoma and report the outcome of conservative surgical treatment of patients diagnosed with this condition in a tertiary referral academic setting over a 20 year period.
METHODS—Retrospective non-comparative case series of consecutive patients diagnosed with iris melanoma from 1980-2000 using medical records from the University of Sydney Department of Ophthalmology and NSW Cancer Registry
RESULTS—51 cases were identified. The most common presentation was growth of a previously noted pigmented lesion. Initial management was either observation or local resection (two had enucleations) with iris reconstruction where possible (23.8%). The mean follow up was 8.7 years (range 1-17 years). Vision of 6/12 or better was maintained in the majority (78.6%) treated by local resection. Pupil reconstruction significantly reduced reported postoperative glare symptoms. Four patients had features suggestive of local recurrence and there was no documented metastatic disease or death from iris melanoma in this series. Histologically, the majority were spindle B cell melanomas. Clinical features including prominent tumour vascularity, rapid growth, and heterogeneous pigmentation were each significantly associated with an epithelioid cell component. Involvement of the iridocorneal angle was frequently associated with ciliary body invasion.
CONCLUSIONS—Management decisions for iris melanoma will depend on the clinical features. Mixed or epithelioid histology is more likely in the presence of two or more of the features of malignancy and may justify earlier intervention. When treatment is undertaken, local resection achieves long term tumour clearance with an acceptable morbidity. In resecting iris melanoma, careful assessment for iridocorneal angle involvement is important in treatment planning. Iris reconstruction has a useful role in reducing postoperative photophobia.



Full Text

The Full Text of this article is available as a PDF (155.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnhill R. L., Fandrey K., Levy M. A., Mihm M. C., Jr, Hyman B. Angiogenesis and tumor progression of melanoma. Quantification of vascularity in melanocytic nevi and cutaneous malignant melanoma. Lab Invest. 1992 Sep;67(3):331–337. [PubMed] [Google Scholar]
  2. Batioğlu F., Günalp I. Malignant melanomas of the iris. Jpn J Ophthalmol. 1998 Jul-Aug;42(4):281–285. doi: 10.1016/s0021-5155(98)00011-2. [DOI] [PubMed] [Google Scholar]
  3. Damato B. E., Paul J., Foulds W. S. Risk factors for metastatic uveal melanoma after trans-scleral local resection. Br J Ophthalmol. 1996 Feb;80(2):109–116. doi: 10.1136/bjo.80.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Damato B. E., Paul J., Foulds W. S. Risk factors for residual and recurrent uveal melanoma after trans-scleral local resection. Br J Ophthalmol. 1996 Feb;80(2):102–108. doi: 10.1136/bjo.80.2.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Demeler U. Fluorescence angiographical studies in the diagnosis and follow-up of tumors of the iris and ciliary body. Adv Ophthalmol. 1981;42:1–17. [PubMed] [Google Scholar]
  6. Foss A. J., Whelehan I., Hungerford J. L., Anderson D. F., Errington R. D., Kacperek A., Restori M., Kongerud J., Sheen M. Predictive factors for the development of rubeosis following proton beam radiotherapy for uveal melanoma. Br J Ophthalmol. 1997 Sep;81(9):748–754. doi: 10.1136/bjo.81.9.748. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Foulds W. S., Damato B. E., Burton R. L. Local resection versus enucleation in the management of choroidal melanoma. Eye (Lond) 1987;1(Pt 6):676–679. doi: 10.1038/eye.1987.110. [DOI] [PubMed] [Google Scholar]
  8. Geisse L. J., Robertson D. M. Iris melanomas. Am J Ophthalmol. 1985 Jun 15;99(6):638–648. doi: 10.1016/s0002-9394(14)76028-3. [DOI] [PubMed] [Google Scholar]
  9. Gündüz K., Shields C. L., Shields J. A., Cater J., Freire J. E., Brady L. W. Plaque radiotherapy of uveal melanoma with predominant ciliary body involvement. Arch Ophthalmol. 1999 Feb;117(2):170–177. doi: 10.1001/archopht.117.2.170. [DOI] [PubMed] [Google Scholar]
  10. Harbour J. W., Augsburger J. J., Eagle R. C., Jr Initial management and follow-up of melanocytic iris tumors. Ophthalmology. 1995 Dec;102(12):1987–1993. doi: 10.1016/s0161-6420(95)30765-8. [DOI] [PubMed] [Google Scholar]
  11. Jakobiec F. A., Silbert G. Are most iris "melanomas' really nevi? A clinicopathologic study of 189 lesions. Arch Ophthalmol. 1981 Dec;99(12):2117–2132. doi: 10.1001/archopht.1981.03930020993002. [DOI] [PubMed] [Google Scholar]
  12. Kara G. B. Excision of uveal melanomas: a 15-year experience. Ophthalmology. 1979 Jun;86(6):997–1023. doi: 10.1016/s0161-6420(79)35408-2. [DOI] [PubMed] [Google Scholar]
  13. McGalliard J. N., Johnston P. B. A study of iris melanoma in Northern Ireland. Br J Ophthalmol. 1989 Aug;73(8):591–595. doi: 10.1136/bjo.73.8.591. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Memmen J. E., McLean I. W. The long-term outcome of patients undergoing iridocyclectomy. Ophthalmology. 1990 Apr;97(4):429–432. doi: 10.1016/s0161-6420(90)32562-9. [DOI] [PubMed] [Google Scholar]
  15. Mueller A. J., Freeman W. R., Folberg R., Bartsch D. U., Scheider A., Schaller U., Kampik A. Evaluation of microvascularization pattern visibility in human choroidal melanomas: comparison of confocal fluorescein with indocyanine green angiography. Graefes Arch Clin Exp Ophthalmol. 1999 Jun;237(6):448–456. doi: 10.1007/s004170050260. [DOI] [PubMed] [Google Scholar]
  16. Naumann G. O., Rummelt V. Block excision of tumors of the anterior uvea. Report on 68 consecutive patients. Ophthalmology. 1996 Dec;103(12):2017–2028. doi: 10.1016/s0161-6420(96)30392-8. [DOI] [PubMed] [Google Scholar]
  17. RONES B., ZIMMERMAN L. E. The prognosis of primary tumors of the iris treated by iridectomy. AMA Arch Ophthalmol. 1958 Aug;60(2):193–205. doi: 10.1001/archopht.1958.00940080207003. [DOI] [PubMed] [Google Scholar]
  18. Seddon J. M., Gragoudas E. S., Albert D. M. Ciliary body and choroidal melanomas treated by proton beam irradiation. Histopathologic study of eyes. Arch Ophthalmol. 1983 Sep;101(9):1402–1408. doi: 10.1001/archopht.1983.01040020404014. [DOI] [PubMed] [Google Scholar]
  19. Shields C. L., Shields J. A., De Potter P., Singh A. D., Hernandez C., Brady L. W. Treatment of non-resectable malignant iris tumours with custom designed plaque radiotherapy. Br J Ophthalmol. 1995 Apr;79(4):306–312. doi: 10.1136/bjo.79.4.306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Shields C. L., Shields J. A., Materin M., Gershenbaum E., Singh A. D., Smith A. Iris melanoma: risk factors for metastasis in 169 consecutive patients. Ophthalmology. 2001 Jan;108(1):172–178. doi: 10.1016/s0161-6420(00)00449-8. [DOI] [PubMed] [Google Scholar]
  21. Shields C. L., Shields J. A., Shields M. B., Augsburger J. J. Prevalence and mechanisms of secondary intraocular pressure elevation in eyes with intraocular tumors. Ophthalmology. 1987 Jul;94(7):839–846. doi: 10.1016/s0161-6420(87)33537-7. [DOI] [PubMed] [Google Scholar]
  22. Shields J. A., Sanborn G. E., Augsburger J. J. The differential diagnosis of malignant melanoma of the iris. A clinical study of 200 patients. Ophthalmology. 1983 Jun;90(6):716–720. doi: 10.1016/s0161-6420(83)34500-0. [DOI] [PubMed] [Google Scholar]
  23. Shields J. A., Shields C. L., Shah P., Sivalingam V. Partial lamellar sclerouvectomy for ciliary body and choroidal tumors. Ophthalmology. 1991 Jun;98(6):971–983. doi: 10.1016/s0161-6420(91)32194-8. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES