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Amy Schefler, Daniel Gologorsky, Brian Marr, Carol Shields, Ignacio Zeolite, David Abramson; Extraocular Extension of Uveal Melanoma After Fine Needle Aspiration, Vitrectomy, or Open Biopsy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4217. doi: https://doi.org/.
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The use of fine needle aspiration biopsy (FNAB) for uveal melanoma has increased dramatically in recent years. Some clinicians have expressed concern for orbital recurrence of melanoma in part because of published experimental evidence indicating that tumor cells can remain in a needle track after experimental biopsy procedures in animal and human eyes. The incidence of tumor cells seeding the FNAB site and causing orbital extension of uveal melanoma in the context of routine clinical care is unknown.
This was a retrospective, multicenter cases series examining cases of orbital recurrence of uveal melanoma after fine needle biopsy, excisional biopsy, or surgery. An international survey was initiated among ocular oncologists who had attended the International Conference of Ocular Oncology in 2011. All reported cases were pooled and clinical and pathologic details were gathered from each contributing institution. Risk factors for recurrence were identified. Four cases were identified, bringing the total number of cases ever reported in the world literature to five.
Four cases worldwide were identified with sufficient information to explore. Two patients underwent excisional biopsy and vitrectomy , one underwent excisional biopsy only, and one underwent FNAB only. All patients had histopathologic confirmation of uveal melanoma and all developed histopathologically confirmed orbital extension. Three developed systemic metastases and one patient died of metastases.
Extraocular extension of uveal melanoma following FNAB, incisional biopsy, and vitrectomy is extremely rare but not impossible. Details related to technique appear to be critical such as needle gauge, number of passes of needle into tumor, manipulation of needle while in the tumor, removal of needle from the eye with compression of the globe at the entry site, number of cells extracted, leakage of vitreous outside the globe, lack of subsequent brachytherapy, and use of cryotherapy at the biopsy site. Continued multicenter collaboration and honest reporting of these rare cases is needed to definitively identify risk factors for this devastating complication.
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