Transscleral Fine Needle Aspiration Biopsy of Macular Choroidal Melanoma

Abstract

Purpose:: Choroidal melanoma is the most common primary intraocular cancer in adults. Despite effective local treatments, at least 50% of patients develop metastatic melanoma. Identification of patients at high risk for metastasis may allow for the initiation of adjunctive therapy and help select patients for participation in clinical trials. For macular choroidal melanoma, we report transscleral fine needle aspiration biopsy (FNAB) to obtain tumor material for cytogenetic and molecular predictive testing at the time of Iodine-125 plaque placement.

Methods:: Retrospective review of 25 consecutive patients with macular choroidal melanoma treated between January 2005 and October 2006. All patients had Iodine-125 plaque surgery with intra-operative transscleral FNAB.

Results:: In 25 patients with macular choroidal melanoma, the mean tumor height was 3.3 mm and 14 of 25 (56%) tumors were less than 3.0 mm in height. FNAB was not feasible in 1 patient. Retinal perforation occurred in 3 of the 24 (12.5%). Subretinal hemorrhage occurred in 10 of the 24 (42%). Vitreous hemorrhage occurred in 5 of the 24 (21%). No patient developed retinal detachment. Complications were self-limited and resolved by 1 month. Definitive pathologic diagnosis was obtained in 18 of the 24 (75%) and cytogenetics with respect to Monosomy 3 was obtained in 13 of the 24 (54%).

Conclusions:: Transscleral FNAB for macular choroidal melanoma may be associated with transient complications and is a feasible procedure to obtain material for cytopathology and cytogenetic studies.

Clinical Trial:: www.clinicaltrials.gov NCT00344799

Keywords: melanoma • choroid • macula/fovea