Introduction:

Uveal melanoma is a rare and potentially aggressive form of ocular cancer that originates from the melanocytes within the uveal tract of the eye. This comprehensive article delves into the intricacies of uveal melanoma, exploring its causes, risk factors, clinical presentation, diagnosis, treatment options, and prognosis.

Understanding Uveal Melanoma:

Uveal melanoma primarily affects the choroid, iris, and ciliary body—the vascular and pigmented layers of the eye. Unlike cutaneous melanoma, which arises from skin melanocytes, uveal melanoma arises within the eye and has distinct characteristics.

Causes and Risk Factors:

The exact causes of uveal melanoma remain unclear, but certain risk factors have been identified:

• Genetics: Genetic mutations, such as alterations in the GNAQ and GNA11 genes, are associated with the development of uveal melanoma.
• Ocular and skin pigmentation: Individuals with fair skin, light-colored eyes, and a history of excessive sun exposure are at a higher risk.
• Age and gender: Uveal melanoma most commonly occurs in individuals between 50 and 70 years of age, and there is a slight predilection for males.

Clinical Presentation:

Uveal melanoma can manifest with various clinical features:

• Choroidal melanoma: This is the most common type of uveal melanoma and often presents as a pigmented mass in the choroid. Patients may experience blurred vision, visual field defects, or floaters.
• Iris melanoma: Iris melanomas appear as pigmented lesions on the iris. They can cause changes in iris color, blurred vision, and eye discomfort.
• Ciliary body melanoma: Melanomas in the ciliary body may lead to increased intraocular pressure, pain, and visual disturbances.

Diagnosis and Evaluation:

Diagnosing uveal melanoma involves a combination of clinical assessment and imaging:

• Ophthalmic examination: Dilated fundoscopy and biomicroscopy help identify the location and extent of the tumor.
• Ultrasonography: A- and B-scan ultrasonography provide detailed images of the tumor's size and location.
• Fluorescein angiography: This imaging technique helps evaluate blood flow and tumor characteristics.
• Optical coherence tomography (OCT): OCT provides cross-sectional images of the tumor and surrounding tissues.

Treatment Options:

Uveal melanoma management is individualized and may include:

• Radiation therapy: Techniques such as plaque brachytherapy or proton beam therapy are commonly used to target and shrink the tumor.
• Enucleation: In advanced cases or when vision is compromised, surgical removal of the eye (enucleation) may be necessary.
• Local therapies: Laser photocoagulation and transpupillary thermotherapy (TTT) can be considered for specific cases.

Prognosis and Follow-Up:

Uveal melanoma prognosis depends on various factors, including tumor size, location, and genetic characteristics. Regular follow-up visits with an ophthalmologist are essential to monitor for recurrence and metastasis.

Conclusion:

Uveal melanoma presents unique challenges due to its location within the eye. By understanding its causes, risk factors, clinical features, diagnosis, and treatment options, healthcare professionals can provide timely intervention and optimize outcomes for individuals affected by uveal melanoma.

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