Brachytherapy and anterior segment imaging in iris melanoma

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Iris melanoma is a rare intraocular malignancy.
• Accurate diagnosis and staging are crucial for effective treatment.
• Ultrasound biomicroscopy (UBM) plays a vital role in evaluating anterior segment tumors.

Purpose of the Study:

• To report a case of iris melanoma diagnosed and treated in a 40-year-old male.
• To highlight the utility of UBM in the diagnosis and management of iris melanoma.
• To evaluate the efficacy of brachytherapy for BAP1-inactivated iris melanoma.

Main Methods:

• Clinical presentation and ophthalmological examination.
• Diagnosis confirmed by Ultrasound Biomicroscopy (UBM) and Fine Needle Aspiration (FNA) with BAP1 gene analysis.
• Treatment with Iodine-125 (I-125) plaque brachytherapy.
• Long-term follow-up using UBM.

Main Results:

• A darkly pigmented iris lesion was identified and diagnosed as iris melanoma.
• UBM confirmed a solid iris stromal mass without ciliary body involvement.
• FNA revealed melanoma with BAP1 gene inactivation.
• Brachytherapy resulted in significant tumor size reduction over three years.
• UBM proved essential for differentiating melanoma from benign lesions and monitoring treatment response.

Conclusions:

• Iris melanoma can be effectively diagnosed using UBM and FNA.
• Brachytherapy is a safe and effective treatment for iris melanoma, even in BAP1-positive cases.
• UBM is indispensable for the accurate assessment and follow-up of uveal melanomas, especially small lesions.