Clinicopathologic Findings in Choroidal Melanomas after Failed Transpupillary Thermotherapy

Abstract

Abstract: : Purpose: To review the clinicopathologic features of eyes enucleated after failed transpupillary thermotherapy. Methods: A retrospective review of the pathology reports in the L.F. Montgomery Laboratory between 1998 and 2002 searched for enucleated eyes with choroidal melanoma that had been treated only by transpupillary thermotherapy (TTT) prior to enucleation. The clinical features of the patients, including ultrasound examination, were reviewed and compared with the pathologic findings. Results: Seven eyes from seven patients had been enucleated, representing 8% of eyes treated with TTT at our institute during the time period studied. The primary indication for enucleation was tumor growth. The melanomas tended to grow laterally, with minimal if any increase in thickness. Five of the seven eyes histologically demonstrated extrascleral extension, which was detected by ultrasound prior to enucleation in only one of those eyes. Conclusions: Choroidal melanoma may continue to grow along a path of least resistance following TTT. The melanoma may extend laterally in the choroid and through emissary canals. Early extrascleral extension may be difficult to detect by ultrasound.

Keywords: melanoma • uvea • pathology: human