Hemorrhage associated with localization of melanoma margins during radioactive plaque placement

Accurate placement of a radioactive plaque is essential in brachytherapy of choroidal melanoma. Various localization techniques, including transillumination of anteriorly located tumours and scleral indentation to mark the anterior margin of posteriorly located tumours, have been used in initially placing a plaque over the base of the tumour. Of 40 consecutive patients treated for choroidal melanoma between 1986 and 1990, 8 had posteriorly located tumours, all localized by means of scleral indentation; subretinal hemorrhage occurred in 3 of the 8 during marking of the tumour margins. No hemorrhages occurred in the 32 patients with tumours localized by means of transillumination (p less than 0.01). It is not clear whether the method of marking or the location of the tumour itself contributed to the development of the hemorrhage. Hemorrhage around the base of a tumour may mask the tumour margins, making assessment of the response to therapy difficult. Caution should be used when marking posteriorly located tumours.