OCULAR ONCOLOGY

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OCULAR ONCOLOGY

• MICHAEL E GIBLIN
• FRANZCO

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OSSN

• Ocular surface squamous neoplasia
• Encompasses conjunctival/corneal intraepithelial
  neoplasia (CIN)
• Squamous conjunctival dysplasia
• Carcinoma in situ
• Invasive squamous cell carcinoma (SCC)

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Squamous cell carcinoma

• Extensive
• Ill defined edges
• Vascularised
• Corneal involvement

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Conjunctival melanoma

• Primary aquired conjunctival melanosis (PAM)
• Preexisting conjunctival naevus
• De novo

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PAM

• Primary acquired conjunctival melanosis

• Biopsy if
• Growth
• Nodule formation
• Vascularity

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De novo conjunctival melanoma
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Rx Conjunctival SCC / Melanoma

• Excision / cryotherapy to cut conjunctival margin
• Topical Mitomycin C
• Episcleral plaque radiotherapy if recurrence

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Iris melanoma
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Congenital hypertrophy of the retinal pigment
epithelium (CHRPE)
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Choroidal neovascularisation high myopia (Fuchs
spot)
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Choroidal haemangioma
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Melanocytic tumours of the posterior uvea

• Naevus
• Melanoma

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Choroidal naevus
Drusen
Fibrous metaplasia of RPE
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Uveal melanoma treatment

• Observation

Tumours lt 2mm thick
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• Symptoms
• Thickness gt 2mm
• Orange pigment (lipofuscin)
• Growth
• Subretinal fluid
• Peripapillary location

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Uveal melanoma treatment

• Observation
• Transpupillary laser thermotherapy (TTT)

Thickness lt 3.5mm
Posterior pole
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Uveal melanoma treatment

• Observation
• TTT
• Local resection

Base lt 10mm
Anterior to equator
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Uveal melanoma treatment

• Observation
• TTT
• Local resection
• Radioactive plaque therapy

Base lt15mm
Thickness lt 8mm
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Iodine 125
Ruthenium 106
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Uveal melanoma treatment

• Observation
• TTT
• Local resection
• Radioactive plaque therapy
• Proton beam/helium ion irradiation
• Gamma knife therapy

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Uveal melanoma treatment

• Observation
• TTT
• Local resection
• Radioactive plaque therapy
• Proton beam/helium ion irradiation
• Gamma knife therapy
• Enucleation

Base gt 15mm
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Metastatic tumours

• Breast / lung carcinoma
• Amelanotic
• Multifocal
• Choroidal
• Treat only if sight affected

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Amelanotic Multifocal Choroidal Posterior to
equator
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M AG ICMI KETHE MEDICI NEMAN