Workup/Staging Flashcards
How do pts with ocular melanoma normally present?
Appx one-third of pts present with blurred vision, and about 30% are asymptomatic. Other presenting Sx include photopsia, scotoma, or pain (rare).
What is the workup for a pt with suspected ocular melanoma?
H&P, CBC, LFTs, ophthalmic/funduscopic/slit lamp exam, visual acuity/visual field testing, US (Kretz A-scan, immersion B-scan), fluorescein angiography, MRI, CT C/A/P or PET/CT to r/o mets
Is Bx necessary for Dx of ocular melanoma?
Not required; it is a clinical Dx made by exam and imaging. There has been historical concern for tumor seeding from Bx, but it has not been associated with the development of DM. The role for Bx has been increasing for molecular analysis and risk stratification.
What are simulation lesions?
Simulation lesions are lesions that may look like melanoma, such as nevi, hemangiomas, retinal detachment, age-related disciform lesions, and mets.
What feature does ocular melanoma manifest on standard A-scan US?
An acoustic “quiet” zone (central hypoechoic area) vs. mets or hemangiomas (have higher internal reflectivity)
What features do ocular melanomas exhibit on fluorescein angiography?
On fluorescein angiography, ocular melanomas exhibit a double circulation pattern and fluorescein leakage (appearing as hot spots).
What is the T staging of choroidal/ciliary body melanoma based on the latest AJCC (8th edition, 2017) staging guidelines?
AJCC staging is based on 4 tumor size categories that depend on tumor diameter and height as follows (Fig. 24.1):
T1: tumor size category 1
T2: tumor size category 2
T3: tumor size category 3
T4: tumor size category 4
For the T staging of choroidal/ciliary body melanomas, what do the designations a–e represent?
a. no ciliary body involvement/extraocular extension
b. with ciliary body involvement
c. no ciliary body/with extraocular extension ≤5 mm in largest diameter
d. with ciliary body/with extraocular extension ≤5 mm
e. with extraocular extension >5
Describe the AJCC staging for choroidal/ciliary body melanomas.
Stage I: T1aN0M0
Stage IIA: T1b–dN0M0 or T2aN0M0
Stage IIB: T2bN0M0 or T3aN0M0
Stage IIIA: T2c–d, T3b–c, T4aN0M0
Stage IIIB: T3d, T4b–cN0M0
Stage IIIC: T4d–eN0M0
Stage IV: T1–4N1M0; T1–4N0–1 M1a–c
For the M staging of choroidal/ciliary body melanomas, what do the designations a–c represent?
M1a: largest diameter of mets ≤3 cm
M1b: largest diameter of mets 3.1–8 cm
M1c: largest diameter of mets >8 cm
In the Collaborative Ocular Melanoma Study (COMS) staging system, what are COMS small, medium, and large lesions?
COMS staging is based on apical height (AH) and basal diameter (BD):
Small: AH 1–3 mm, BD 5–16 mm
Medium: AH 3.1–8 mm, BD 5–16 mm
Large: AH >8 mm and/or BD ≥16 mm
What are the 10-yr OS rates of COMS small, medium, and large tumors? Pts with DM?
10-yr OS for COMS tumors:
Small: 80%
Medium: 60%
Large: 30%–40%
DM pts: <7 mos
