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      Small Choroidal Melanoma: Correlation between Clinical Characteristics and Metastatic Potential


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          Importance: Diagnosis of small choroidal melanoma is based upon clinical features and presence of factors predictive of local malignant growth. Prognostic biopsy quantifies risk of metastasis. Objective: The aim of this study is to explore relationship between clinical characteristics and metastatic potential of a small choroidal melanoma. Design: Retrospective review of 53 patients with small choroidal melanoma treated in a tertiary oncology clinic. Patients were derived from 3 cohorts, with pathologic confirmation, with growth confirmation, and those treated only on clinical basis. Based upon prognostic biopsy outcomes, each case was classified into low or high metastatic potential groups. Distribution of clinical characteristics such as age, laterality, symptoms, tumor dimensions, tumor distance from optic nerve and fovea, presence of surface orange pigment, drusen, retinal pigment epithelial atrophy, and subretinal fluid was analyzed between metastatic groups. Main Outcome Measures: Distribution of clinical characteristics between low or high metastatic potential groups was analyzed. Results: A total of 53 patients [mean age, 61 years (range, 27–81 years); 32 (60%) men and 21 (40%) women] were classified into pathology confirmed group ( n = 13), growth confirmed group ( n = 26), and with clinical group ( n = 14). Prognostic biopsy in the growth, pathology, and clinical groups revealed low metastatic potential in 23, 10, and 11 patients, respectively, and high metastatic potential in 3 patients in each group. Distribution of clinical characteristics between low or high metastatic potential groups was not statistically significantly different. Conclusion: Clinical characteristics do not identify metastatic potential of a small choroidal melanoma.

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          Most cited references63

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          Variation of monosomy 3 status within uveal melanoma.

          Determining the most significant prognostic variables in uveal melanoma is important for stratifying patients for metastasis surveillance and possible initiation of chemotherapy or immunotherapy. Monosomy 3, one such variable, can be determined using fluorescence in situ hybridization, either on enucleated samples, fine-needle aspiration biopsy, or tumor sample obtained by vitrector. To evaluate possible regional discordance in chromosome 3 by sites likely to be sampled by different biopsy methods. Eighteen consecutive patients with uveal melanoma who underwent primary enucleation were studied. Representative paraffin blocks were selected based on review of hematoxylin-eosin stained sections, and the apex and base of each tumor was demarcated. Unstained paraffin sections, 4 mum in thickness, were prepared, and fluorescence in situ hybridization, looking for monosomy 3, was performed. The chromosomal analysis was also correlated with histologic evaluation for melanoma cell type (spindle vs epithelioid cell), ciliary body involvement, presence of positive periodic acid-Schiff vascular mimicry patterns, scleral or extrascleral spread and size. One case was excluded because of necrosis. Ten of the 17 remaining cases (59%) demonstrated monosomy 3 (in either the base or both base and apex of the tumor) with 7 cases (41%) showing disomy. Seven cases (70%) with monosomy 3 demonstrated this in both the apex and the base locations, whereas 3 cases (30%) showed monosomy in one location only (always at the base). Fourteen of the 17 cases (82%) revealed concordance in chromosome 3-monosomy 3 (7 of 14, 50%) or chromosome 3-disomy 3 (7 of 14, 50%). All 3 discordant cases demonstrated the monosomy 3 at the base with disomy at the apex. Lack of concordance between the base and apex did not correlate with melanoma cell type. Prognostic variables are important in management of neoplasms, and this study points out that the site of tissue biopsy for prognostication in uveal melanoma could affect the results obtained, at least for the presence of monosomy 3.
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            Small choroidal melanoma with chromosome 3 monosomy on fine-needle aspiration biopsy.

            To evaluate the presence of chromosome 3 monosomy in small choroidal melanoma using fine-needle aspiration biopsy (FNAB). Noncomparative case series. Fifty-six patients with small choroidal melanoma measuring 3 mm or less in thickness who were undergoing plaque radiotherapy. Fine-needle aspiration biopsy was used at the time of plaque radiotherapy to sample tumor cells using a 27-gauge long needle via an indirect transvitreal approach into the tumor apex for postequatorial tumors or a 30-gauge short needle via a direct transscleral approach into the tumor base for preequatorial tumors. Chromosome 3 monosomy in small choroidal melanoma. The median tumor thickness was 2.6 mm. Monosomy 3 was found in 15 (27%) cases and disomy 3 was found in 32 (57%) cases. In 9 (16%) cases, genomic DNA yield was insufficient for genetic analysis. Fine-needle aspiration biopsy with a 27-gauge needle transvitreal approach provided quantity sufficient for genetic testing in 31 (97%) of 32 cases versus 16 (67%) of 24 cases sampled with a 30-gauge transscleral technique. Compared with disomy 3 tumors, monosomy 3 tumors were statistically more likely to occur in older patients (P = 0.040). Monosomy 3 (versus disomy 3) tumors showed thickness of more than 2 mm in 100% (vs. 84%), subretinal fluid in 87% (vs. 94%), symptoms in 40% (vs. 56%), orange pigment in 93% (vs. 81%), and margin of 3 mm or less to the optic disc in 20% (vs. 50%). There was no statistical difference between monosomy 3 and disomy 3 tumors in the presence or number of these clinical factors. However, small choroidal melanomas with monosomy 3 mutation were more likely to have had documented growth (63%) compared with those with disomy 3 (25%; P = 0.025; odds ratio, 5.00). Using FNAB at the time of plaque radiotherapy, monosomy 3 was found in approximately 27% of small choroidal melanomas, more often in older patients and tumors with documented growth. Transvitreal biopsy into the tumor apex provided better yield compared with transscleral biopsy into the tumor base.
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              Frequency and Implications of Discordant Gene Expression Profile Class in Posterior Uveal Melanomas Sampled by Fine Needle Aspiration Biopsy


                Author and article information

                Ocular Oncology and Pathology
                S. Karger AG
                December 2021
                16 September 2021
                : 7
                : 6
                : 437-446
                [_a] aDepartment of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
                [_b] bOphthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
                Author information
                519672 Ocul Oncol Pathol 2021;7:437–446
                © 2021 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 13 May 2021
                : 10 September 2021
                Page count
                Figures: 3, Tables: 2, Pages: 10
                Research Article

                Vision sciences,Ophthalmology & Optometry,Pathology
                Small choroidal melanoma,Histopathology,Growth rate,Diagnosis


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