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Monica Oxenreiter, Anne Marie Lane, Ivana K Kim, Evangelos S Gragoudas; MANAGEMENT OF SUSPICIOUS MELANOCYTIC LESIONS OF THE IRIS. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4419.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the natural history of indeterminate pigmented lesions of the iris.
We identified 260 patients evaluated at the Massachusetts Eye and Ear Infirmary for suspicious iris lesions between January 2009 and October 2015, and calculated rates of malignant transformation and metastasis. Melanoma-related mortality in these patients was compared to a group of patients diagnosed with iris or iridociliary melanomas originating in the iris (N=23) during the same period.
Overall, median follow up was 5.7 years. Median VA at last follow-up was 20/25. Mean lesion height was 0.91 mm (range: 0-3.5) for patients with suspicious lesions and 3.46 mm (range: 1.2-6.5mm) for patients with melanomas. Thirteen (5.0%) lesions underwent malignant transformation; mean time from presentation to diagnosis was 76.4 months. These patients were treated with proton therapy with a light-field technique, and three (23.1%) developed complications (secondary glaucoma and NVG in one patient, rubeosis in the second patient, and rubeosis and NVG in the third). One patient (0.38%), followed for 98.4 months before being diagnosed with melanoma, developed metastasis 31.7 months after receiving proton therapy, and died of melanoma 1.5 months after metastasis diagnosis. Ten patients (43.5%) initially diagnosed with melanoma developed complications, including rubeosis (n=5), NVG (n=3), and secondary glaucoma (n=5). Four patients (17.4%) in the melanoma group died from malignant melanoma; time from treatment to metastasis was 26.8 months and time from metastasis to death was 1.3 months.
These data provide evidence that indeterminate melanocytic iris lesions have low malignant potential and that current conservative methods of follow-up are reasonable.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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