1. With uveal melanoma
The uvea, it is a general term ciliary body and iris, choroid. Color is brown, I is located between the retina and strong film of the eye. The organization that belongs to the uvea, is responsible each, iris to adjust the light entering the eye, ciliary body at a constant temperature of the eye or to provide nutrients to the retina choroid to focus, rich in blood vessels I want to work and. The uveal malignant melanoma, melanin cells containing many, refers to those cancer into this grape film. It is said than tumors that occur in the skin and mucous membranes, and is slightly malignancy is low. Annual incidence in Japan, 2.5 people to 10 million. Not so much difference between regional and gender, there is a tendency that the incidence will rise with increasing age, there is almost no generation from children. The frequency of occurrence of white high, as much as 43 people per 10 million, the development of approximately 17 times the size of Japan has been reported If you look at the world. It is described for one of the risk factors of developing a uveal melanoma is ultraviolet light, this is because, the amount of ultraviolet light enters the eyes of many white pigment of the iris is thin. It should be noted that, indeed, incidence is higher the area is strong sunlight near the equator.
2. Symptom
The iris malignant melanoma, be found in the deformation of the pupil is large masses of blotchy black iris also, as (mainstream), it may be discovered by complicated by glaucoma. The ciliary body melanoma, that it may give rise to cataract by compressing the lens, to visit and conscious vision loss position of the lens is to be shifted is the majority. Choroidal malignant melanoma, the symptoms will vary the location of the tumor, depending on the size, but the vision loss is most often, then you may have (there is an invisible part, the upper half and not visible) visual field abnormalities. There are also symptoms such as: (I feel like a mosquito flying in front of Hibunsho) other, you (look distorted) metamorphopsia, floaters. In addition, there is much if the tumor is discovered by chance to have visited the ophthalmology in other symptoms, and underwent fundus examination. Tumor is increased by proceeding, and other symptoms (with loss of vision) hyperemia and eye pain caused by glaucoma will appear.
3. Diagnosis
The diagnosis of uveal malignant melanoma, and fundus examination (most fierce fight) microscopy is a slit-lamp examination ophthalmic will be basic. As imaging ancillary, there ultrasonography, and MRI examination. To the pathological examination, because other than the enucleated technically difficult, treatment may be determined on the basis of clinical diagnosis. When observed with a slit lamp microscope in the iris malignant melanoma, it appears as a black mass was raised from the iris surface. Ultrasonography of the high frequencies, and measuring the size of the iris tumor, suspect strongly melanoma when there is increasing tendency. In addition, there is a case of benign blisters which are common to the iris ciliary body of iris cyst When the inspection. In the ciliary body melanoma, tumor that compresses the lens can be seen from the gap between the lens and iris. Verify the existence and spread in diagnostic imaging such as MRI examination and ultrasonography, suspect strongly malignant melanoma If there is increasing tendency. In choroidal malignant melanoma, performing fundus examination, tumor hemispherical looks blackish brown under the retina. If there is activity in the tumor, it will cause a retinal detachment exudate from the tumor is collected in the back of the retina. Further, the fluorescent fundus angiography, leakage and punctate contrast agent was injected in the portion of the tumor, the reservoir is confirmed. There is no characteristic findings in small masses, definitive diagnosis is difficult. Even in a large-scale study was conducted in North America, because the diagnosis can not be reliably, it is recommended to follow-up when the thickness of the tumor is less than 3mm. If you have confirmed an increase in the tumor in follow-up, and the emergence of retinal detachment, and then diagnosed with malignant melanoma clinically. Based on the clinical diagnosis like this, diagnostic concordance rate when you make eye removed as a result is very high and 99.5%, it is determined that treatment based on clinical diagnosis is reasonable.
4. Staging
In uveal malignant melanoma, staging is not established. In choroidal malignant melanoma, for the treatment decision making, small (the thickness of the tumor is more than 5mm tumor diameter and 1 ~ 3mm), 16mm less than the tumor diameter and 10mm from 2-3 the thickness of (tumor medium intraocular tumor comparison test) classification of malignant melanoma that have been made (Collaborative Ocular Melanoma Study, in North America has been commonly used COMS tumor diameter or 10mm or more is classified into three groups of 16mm or more) the thickness of the large (tumor) You.
5. Treatment
The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different. Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.
The iris malignant melanoma, tumor if confined to the iris, it is possible to be removed by surgery. After surgery, can cause progression of cataract, and deformation of the pupil. Make enucleation if the tumor cells have spread to the eye within. In the ciliary body melanoma, it can be said to be able to remove a tumor in the range of 30% or less of the ciliary body, treatment with surgery is good. If you tumor diameter less than 15mm even if it is larger than this, brachytherapy due to the radiation treatment is possible. It is a treatment enucleation is reasonable if it is large 15mm or more. In choroidal malignant melanoma, treatment policy varies depending on the size. Mentioned above, the observation with no treatment for small tumors, perform the therapy according to the medium tumor only when the tumor growth was observed. In the case of medium tumors, since in case of providing a brachytherapy is typical with the eye removed, that there is no difference in mortality has been demonstrated by a randomized clinical trial COMS, and making a brachytherapy now You have more. In the case of large tumors, enucleation is a reasonable choice. The COMS, for large tumors, in the case of performing enucleation immediately comparison when performing irradiation excision prior studies or reduce tumor metastasis has been but the radiation preoperative a result that is not valid has come out. In addition, to irradiate the lesion particle radiation such as heavy particle or proton particle beam treatment of the validity of a special radiation have also been reported. Result difference is that, not compared with brachytherapy proton beam irradiation has been reported from several facilities, in Japan, treatment with heavy particle beam therapy, such as carbon ions are carried out research, the therapeutic effect of tumor is becoming recognized. Even in choroidal malignant melanoma, there is a treatment to excise the tumor only to leave the eye. Because of that require a high degree of skill, may produce serious complications of proliferative vitreoretinopathy and bleeding in the eyeball, adaptation is limited. If there is a partial relapse following treatment, or when the thickness of the tumor is small, you can make the heat treatment with an infrared laser. It may require multiple treatments, bleeding, results in inflammation within the eye. There is currently no effective treatment for metastatic. Since there is no lymphoid tissue in the uvea, tumor metastasis will occur along with the flow of blood. Many, especially in the liver metastases, it is possible that is found in the case of about two-thirds, and found lung, bone, even in the subcutaneous other. In the case where it is spread to the liver only, you can take the method of embolization chemotherapy, but the results 71% in one year, the survival rate of 42% over two years has come out.
The brachytherapy
is a treatment that is removed where using radioisotopes shape to match the curved surface of the eye, fixed to the portion corresponding to the tumor from outside the eye wall surgically this, a certain time has elapsed. I’m using a radioactive isotope of ruthenium 106 in Japan. Iodine 125, 103 and palladium are used in Europe and the United States. The release of β-ray, ruthenium 106 can be irradiated with enough radiation to tumors to a thickness of about 5mm. For dampening distance leaves, treatment methods developed for the fraction of only about irradiated on the wall of the contralateral eye is irradiated enough radiation therapy while reducing radiation damage of the surrounding tissue is. During treatment, the fact that there is a possibility of exposure to around, you need to spend in a special hospital room that is shielded enough. Never radioactivity remaining after removal of the source, normal life is possible. As a complication, you might move radiation retinopathy, cataract, eye is slightly restricted.
6. Prognosis
The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different.
Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.
The tumor to be found within a very small, tissue-type is also good prognosis malignancy compared to the choroidal malignant melanoma low, but the iris malignant melanoma, has been transition to occur is about 5% in 10 years . Choroidal malignant melanoma and ciliary body, be evaluated separately exactly is difficult. Cases that proceed from that discovery is often difficult to ciliary body melanoma in general, has been a poor prognosis. The result of the comparison test by COMS, in tumors of medium size, 82% 5-year survival rate. If you look at the result of the lapse of ’12, there was no difference in prognosis in brachytherapy and first enucleation. The success rate can be saved ocular 85% for five years if the treatment is brachytherapy. The large size of the tumor, the 5-year survival rate is 57% even after the first enucleation, irradiation before enucleation was not seen the effect of metastasis prevention. 79% 5-year, 56% in ’10, the survival rate of enucleation after in Japan, was 41% in ’15.
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