OCULAR ONCOLOGY

OCULAR ONCOLOGY

MICHAEL E GIBLIN

FRANZCO

OSSN

• Ocular surface squamous neoplasia• Encompasses conjunctival/corneal

intraepithelial neoplasia (CIN)

• Squamous conjunctival dysplasia• Carcinoma in situ• Invasive squamous cell carcinoma

(SCC)

Squamous cell carcinoma

•Extensive

•Ill defined edges

•Vascularised

•Corneal involvement

Conjunctival melanoma

• Primary aquired conjunctival melanosis (PAM)

• Preexisting conjunctival naevus• De novo

PAM

• Primary acquired conjunctival melanosis

Biopsy if:•Growth•Nodule formation•Vascularity

De novo conjunctival melanoma

Rx Conjunctival SCC / Melanoma

• Excision / cryotherapy to cut conjunctival margin

• Topical Mitomycin C• Episcleral plaque radiotherapy if

recurrence

Iris melanoma

Congenital hypertrophy of the retinal pigment epithelium (CHRPE)

Choroidal neovascularisation: high myopia (Fuch’s spot)

Choroidal haemangioma

Melanocytic tumours of the posterior uvea

• Naevus• Melanoma

Drusen Fibrous metaplasia of RPE

Choroidal naevus

Uveal melanoma treatment

• Observation

Tumours < 2mm thick

• Symptoms• Thickness > 2mm• Orange pigment (lipofuscin)• Growth• Subretinal fluid• Peripapillary location

Uveal melanoma treatment

• Observation• Transpupillary laser thermotherapy

(TTT)

Posterior pole

Thickness < 3.5mm

Uveal melanoma treatment

• Observation• TTT• Local resection

Anterior to equator

Base < 10mm

Uveal melanoma treatment

• Observation• TTT• Local resection• Radioactive plaque therapy

Thickness < 8mmBase <15mm

Ruthenium 106

Iodine 125

Uveal melanoma treatment

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

Uveal melanoma treatment

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

Base > 15mm

Metastatic tumours

• Breast / lung carcinoma

• Amelanotic• Multifocal• Choroidal

• Treat only if sight affected

Amelanotic

Multifocal

Choroidal

Posterior to equator

MAGICMI

KETHEMEDICINEMAN