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Small choroidal melanoma

detection with multimodal imaging and management with plaque radiotherapy or AU-011 nanoparticle therapy

Shields, Carol L.; Lim, Li-Anne S.; Dalvin, Lauren A.; Shields, Jerry A.

Current Opinion in Ophthalmology: May 2019 - Volume 30 - Issue 3 - p 206–214
doi: 10.1097/ICU.0000000000000560
TRANSLATIONAL RESEARCH: Edited by Jason Hsu and Sunir J. Garg
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Purpose of review To explore risk factors for choroidal nevus transformation into melanoma using multimodal imaging and review current treatment options.

Recent findings A recently published longitudinal study of 3806 choroidal nevi, imaged with optical coherence tomography (OCT), ultrasonography, and standard wavelength autofluorescence, revealed transformation into melanoma in 5.8% at 5 years and 13.9% at 10 years, using Kaplan–Meier analysis. Multivariate factors predictive of transformation included thickness more than 2 mm (by ultrasonography), fluid subretinal (by OCT), symptoms vision loss (by Snellen acuity), orange pigment (by autofluorescence), melanoma hollow (by ultrasonography), and DIaMeter more than 5 mm (by photography). These important factors can be recalled by the mnemonic ‘To Find Small Ocular Melanoma Doing IMaging’ (TFSOM-DIM). The mean 5-year estimate of nevus growth into melanoma was 1.1% for those with 0 risk factor, 11% with one factor, 22% with two factors, 34% with three factors, 51% with four factors, and 55% with five risk factors. Management of small choroidal melanoma typically involves plaque radiotherapy with 5 and 10-year rates of tumor recurrence at 7 and 11%, visual acuity loss (≥3 Snellen lines) at 39 and 49%, and melanoma-related metastasis at 4 and 9%. A novel infrared dye-conjugated virus-like nanoparticle (AU-011) is currently under investigation for treatment of small choroidal melanoma, with a goal to induce tumor regression and minimize vision loss.

Summary The mnemonic, TFSOM-DIM, can assist the clinician in detection of small choroidal melanoma. Treatment of small melanoma with plaque radiotherapy offers tumor control but with potential vision loss. A novel nanoparticle therapy using AU-011 is currently under trial.

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Correspondence to Carol L. Shields, MD, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, USA. Tel: +1 215 928 3105; fax: +1 215 928 1140; e-mail: carolshields@gmail.com

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