Treatment of amelanotic choroidal melanoma with photodynamic therapy

To evaluate the effect of photodynamic therapy on amelanotic choroidal melanoma.

Nine patients with posteriorly located amelanotic choroidal melanomas, one with a pigmented portion, underwent photodynamic therapy using verteporfin as the photosensitizing agent. The basal diameters ranged from 4 mm to 16 mm and the heights from 1.3 mm to 5.7 mm. Treatment was repeated until the melanoma was completely flat or its height had reached a stable end point. Tumor response was assessed by clinical examination, photography, and ultrasonography. Annual screening for hepatic metastases was performed.

Eight tumors demonstrated apparent complete regression over 1 month to 14 months. The amelanotic portion of the mixed tumor flattened, whereas the height of the pigmented part remained stable at 2 mm. In 8 patients there has been no recurrence during follow-up of between 34 months and 81 months. One case developed 2 separate local recurrences at 21 months and 34 months. There were no serious complications, no patient lost vision after treatment, and none developed metastatic disease.

In this series photodynamic therapy was highly effective in causing regression of posteriorly located amelanotic choroidal melanomas, without a detrimental effect on vision. While the short-term results are encouraging, there is some uncertainty regarding complete tumor destruction and long-term efficacy.