Surgical treatment of ocular melanoma

Malignant melanomas may arise in the uveal tract, the conjunctiva, the skin of the eyelid, or the orbit. Risk factors so far identified include pre-existing choroidal naevi for uveal melanomas, primary acquired melanosis (PAM) for conjunctival tumours, and ocular and oculodermal melanocytosis for uveal and orbital lesions. The atypical mole syndrome (AMS) is associated with uveal and conjunctival melanomas, especially when the ocular lesions are multiple or familial. AMS patients should be screened for ocular melanomas. Conjunctival melanomas are managed by excision with or without adjunctive beta-irradiation. Circumscribed tumours have a better prognosis than diffuse and multifocal lesions arising in acquired melanosis and attempts should be made to limit the progress of the latter variant of the disease by treating PAM with cryotherapy. The most significant prognostic factor in uveal melanoma is the size of the tumour at presentation. Early dissemination is the rule and every effort should be made to distinguish a melanoma from a naevus as soon as possible. Small and medium-sized melanomas respond well to focal treatments chosen according to the size and location of the tumour. The techniques employed include photocoagulation, radioactive plaque therapy, proton beam radiotherapy and surgical resection.