Uveal Melanoma-Associated Pain: Clinical Features and Pain Characteristics

Abstract

Purpose : To characterize clinical features and pain with uveal melanoma.

Methods : Retrospective chart review of sixty-three consecutive uveal melanoma patients that presented with pain. Pain features included laterality, location, quality, frequency, duration, and pain rating. Data on imaging studies, tumor features and outcomes were also reviewed.

Results : The median age was 60 years (range 22-85) and most were female (62%). Pain was ipsilateral (93%), and often the only symptom (28%). Pain was sudden-onset (64%), intermittent (71%), severe (51%) and mean pain score was 7/10. The mean tumor base was 14 mm (median 14, range 5-22) and thickness was 7 mm (6, 1-20). The predominant tumor location was equator-macula (68%). On ultrasonography, choroidal excavation suggestive of tumor necrosis was seen in 44%. Compared to a published cohort of uveal melanoma (n=7256), Bruch membrane rupture (37% vs 22%, p=0.003) and mushroom shape (37% vs 19%, p<0.001) were more common in melanoma with pain. Pain resolved (79%) within 4 months after melanoma treatment. Of this, 72% received plaque brachytherapy, 26% had enucleation, and 2% underwent photodynamic therapy.

Conclusions : Pain can be the only presenting symptom of uveal melanoma and could be related to tumor necrosis or mushroom configuration. It is important to consider uveal melanoma in the differential diagnosis of unexplained headache or eye pain.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Headache & ocular pain in necrotic choroidal melanoma in the setting of normal intraocular pressure. Case 1: a 48-year-old Caucasian male with sudden-onset right-sided ocular pain. Anterior segment was quiet (A). Fundoscopy revealed a pigmented choroidal melanoma (B), measuring 5 mm thick. Ultrasonography (C) showed central choroidal excavation, suggestive of tumor necrosis. Case 2: a 42-year-old Caucasian male presented with gradual-onset left-sided headache and ocular pain not resolving after steroid drops for 10 days. Note moderate episcleral injection (D) and a pigmented choroidal melanoma (E). Ultrasonography (F) revealed tumor thickness of 6 mm, central choroidal excavation, and subretinal fluid. Case 3: a 50-year-old African American female with severe right-sided periorbital pain with a normal anterior segment (G) and a lightly pigmented choroidal melanoma (H). Ultrasonography (I) showed a hollow tumor of 5 mm thickness and central choroidal excavation.