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Clinical and Pathologic Characteristics of Biopsy-Proven Iris MelanomaA Multicenter International Study
Samira Khan, MD;
Paul T. Finger, MD;
Guo-Pei Yu, MD, MPH;
Lubna Razzaq, MD;
Martine J. Jager, MD;
Rob J. W. de Keizer, MD;
Per Sandkull, MD;
Stefan Seregard, MD;
Daniel Gologorsky, MD;
Amy C. Schefler, MD;
Timothy G. Murray, MD;
Tero Kivelä, MD;
Gian Paolo Giuliari, MD;
Hugh McGowan, MD;
E. Rand Simpson, MD;
Christine Corriveau, MD;
Sarah E. Coupland, MBBS, PhD;
Bertil E. Damato, MD
Arch Ophthalmol. 2012;130(1):57-64. doi:10.1001/archophthalmol.2011.286
Objective To collaborate with multiple centers to identify representative epidemiological, clinical, and pathologic characteristics of melanoma of the iris. This international, multicenter, Internet-assisted study in ophthalmic oncology demonstrates the collaboration among eye cancer specialists to stage and describe the clinical and pathologic characteristics of biopsy-proven melanoma of the iris.
Methods A computer program was created to allow for Internet-assisted multicenter, privacy-protected, online data entry. Eight eye cancer centers in 6 countries performed retrospective chart reviews. Statistical analysis included patient and tumor characteristics, ocular and angle abnormalities, management, histopathology, and outcomes.
Results A total of 131 patients with iris melanoma (mean age, 64 years [range, 20-100 years]) were found to have blue-gray (62.2%), green-hazel (29.1%), or brown (8.7%) irides. Iris melanoma color was brown (65.6%), amelanotic (9.9%), and multicolored (6.9%). A mean of 2.5 clock hours of iris was visibly involved with melanoma, typically centered at the 6-o’clock meridian. Presentations included iritis, glaucoma, hyphema, and sector cataract. High-frequency ultrasonography revealed a largest mean tumor diameter of 4.9 mm, a mean maximum tumor thickness of 1.9 mm, angle blunting (52%), iris root disinsertion (9%), and posterior iris pigment epithelium displacement (9%). Using the American Joint Commission on Cancer–International Union Against Cancer classification, we identified 56% of tumors as T1, 34% of tumors as T2, 2% of tumors as T3, and 1% of tumors as T4. Histopathologic grades were G1-spindle (54%), G2-mixed (28%), G3-epithelioid (5%), and undetermined (13%) cell types. Primary treatment involved radiation (26%) and surgery (64%). Kaplan-Meier analysis found a 10.7% risk of metastatic melanoma at 5 years.
Conclusions Iris melanomas were most likely to be brown and found in the inferior quadrants of patients with light irides. Typically small and unifocal, melanomas are commonly associated with angle blunting and spindle cell histopathology. This multicenter, Internet-based, international study successfully pooled data and extracted information on biopsy-proven melanoma of the iris.
Author Affiliations: The New York Eye Cancer Center, New York University School of Medicine, The New York Eye and Ear Infirmary, New York City (Drs Khan, Finger, and Yu); Department of Ophthalmology, Leiden University Medical Center, the Netherlands (Drs Razzaq, Jager, and de Keizer); Department of Ophthalmic Pathology and Oncology, St Erik's Eye Hospital, Stockholm, Sweden (Drs Sandkull and Seregard); Bascom Palmer Eye Institute, Miami, Florida (Drs Gologorsky, Schefler, and Murray); Department of Ophthalmology, Helsinki University Central Hospital, Finland (Dr Kivelä); Department of Ophthalmology, Princess Margaret Hospital, Toronto (Drs Giuliari, McGowan, and Simpson), and Department of Ophthalmology, University of Montreal, Quebec (Dr Corriveau), Canada; and Department of Cellular and Molecular Pathology (Dr Coupland) and Department of Ophthalmology (Dr Damato), Royal Liverpool University Hospital, England.
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