Treatment Options for Small Choroidal Melanoma

Observation. This strategy is important for patients with an uncertain diagnosis or whose tumor growth has not been documented. It is also used for asymptomatic patients with stable lesions (particularly older or debilitated patients) and for patients with a tumor in their only useful eye.[2]

Plaque radiation therapy. This treatment is used for small- or medium-sized uveal melanomas, amelanotic tumors, or tumors that touch the optic disc for greater than 3 clock-hours of optic disk circumference.[7,8]

External-beam, charged-particle radiation therapy. This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.[7-10]

Gamma-knife radiation surgery. This treatment may be a feasible option for small- to medium-sized melanomas.[11-13]

Transpupillary thermotherapy. As noted above, this approach has very limited use, but it can be used as a primary treatment or as an adjunctive method to plaque radiation therapy.[5,6,14-18] For more information, see the Transpupillary Thermotherapy section.

Local tumor resection. This strategy is used mainly for selected ciliary body or anterior choroidal tumors with smaller basal dimensions and greater thickness.[19]

Enucleation. This approach is used when severe intraocular pressure elevation is a factor. It may also be considered with small- and medium-sized melanomas that are invading the tissues of the optic nerve.[20]