Dr Rajvin Samuel

Malignant

melanoma

otherwise called Melanocarcinoma It is a cancerous condition arising from melanocytes.

 Eyelids Conjunctiva Uvea

[iris ,Ciliary body, Choroid]

 Invasive

proliferation of intraepidermal melanocytes

Factors : 1.Congenital,dysplastic nevi 2.Changing cutaneous moles 3.Excessive sun exposure 4.Family history 5.Caucasian race

Risk

Lentigo maligna melanoma[flat macule]

Superficial spreading [elevated slightly]

Nodular melanoma[ size , ulcer , bleed]

Diagnosis :
- Excisional biopsy

Treatment :
It is a radio resistant. - Wide surgical excision[Histo monitor] - Regional lymph node dissection

 Raised

pigmented /non pigmented lesion of substantia propria

Limbal/perilimbal

conjunctiva [nasal/temporal]

interpalpebral fissure

Originate

from basal layers of epithelium

 Associated
Contains Invades

with preexisting nevus or de novo

numerous prominent blood vessels

blood vessels,lymphatic vessels, cornea , sclera. size,solidity, fixation to underlying sclera - suspect malignant melanoma

Increased

 TX

- Primary tumor cannot be assessed TO - No evidence of primary tumor T1 - Tumor(s) of bulbar conjunctiva occupying 1 quadrant or less T2 - Tumor(s) of bulbar conjunctiva occupying more than 1 quadrant T3 - Tumor(s) of conjunctival fornix and/or palpebral conjunctiva and/or caruncle T4 - Tumor invades eyelid, cornea, and/or orbit

 Nx

Regional lymph node not assessed No - No regional lymph node metastasis N1 - Metastasis in only one lymph node N2 - Metastasis in 2 or more regional lymph nodes with intralymphatic vessel metastasis N3 Nodal metastasis

 Mx

Distant metastasis not assessed Mo - No distant metastasis M1 - Distant metastasis

 Treatment:

- Complete excision with cryotherapy - Contact radiation therapy - exenteration

Malignant neoplasm arises from neuroectodermal melanocytes in choroid,ciliary body/iris

 Ocular
Visible

manifestations

spot /discolouration of iris one eye size, apparent cohesiveness, intrinsic vascularity IOP , Pupillary peaking , ectropion iridis , iris splinting

Transpupillary /transconjunctival transscleral illumination Anterior segment photography /Goniophtography

Fluorescein angiography
Ultrasound biomicroscopy Incisional biopsy & fine needle aspiration biopsy

 Observation Excision Plaque

[iridectomy/iridocyclectomy]

radiotherapy

Enucleation

 Ocular

manifestations:

blurry vision, visual field defects, floaters,flashes Ciliary body melanoma : Trans scleral extension pigmented epibulbar nodule peripheral fundus Dilated blood vessels

Dark brown golden , biconvex lenitcular /dome mushroom shape

Orange patches appear in RPE due to lipofuscin accumulation

Associated with non rhegmatogenous retinal detachment - Clear serous shifting sub retinal fluid

 B-SCAN
A

SCAN [High to low amplitude internal reflectivity echoes] Fluorescein angiography -[RPE involvement ,vascular leakage, SR fluid] Indocyanine angiography - [Hypofluorescent mass] CT MRI [ hyperintensity relative to vitreous]

 Enucleation
Radiation

therapy Observation Microsurgical resection - External trans scleral resection - Transvitreal endo resection Laser therapy - Transpupillary thermotherapy [diode infrared laser] Exenteration

THANK YOU