Local resection of choroidal melanoma: Weighing the pros and cons

Resection of choroidal tumours is a treatment option but it is technically challenging and more challenging than removing tumours in the iris and ciliary body because the choroid is less accessible.¹

In a review of the literature on surgical procedures to remove choroidal tumours via endoresection (ab interno) or transscleral resection (ab externo), Spanish investigators found that local resection may offer better visual results and eye sparing without compromising local tumour control and survival, but there are come caveats attached,¹ according to lead author Dr Josep Maria Caminal, MD, from the Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain.

The investigators used the PubMed database of the U.S. National Library of Medicine and the Cochrane Central Register of Controlled Trials of the Cochrane Library to compare the 2 methods of choroidal tumour excision for visual outcomes, survival rates, and complications.

Twenty-five studies met the inclusion criteria; 12 studies described exoresection (6 retrospective studies and 6 comparative studies) and 13 describedendoresection (11 retrospective and 2 comparative studies).

The investigators reported that both surgeries are indicated to remove large tumours with thicknesses exceeding 8 mm with small base diameters. In addition to eliminating the risk associated with radiotherapy, surgery provides clinicians the opportunity to obtain histopathologic and cytogenetic data from surgical specimens. However, both surgeries are challenging and carry the risk of severe early and late postoperative complications.

Dr Caminal and colleagues provided the following key points:

“Choroidal tumour resection is an alternative to brachytherapy in selected cases. The available data suggest that this approach may offer better visual results and eye sparing without compromising local tumour control and survival.

Resection techniques for choroidal tumours are based on modern vitreoretinal surgical techniques, which allow for the treatment of more challenging cases.

The main limitations to surgical resection of these tumours are the risk of severe complications, which may include retinal detachment, proliferative vitreoretinopathy, severe intraoperative hemorrhage, air embolism, and local tumour recurrence at the resection edge.

Surgical resection of uveal melanomas should be limited to centers with substantial experience in the management of intraocular tumours.”

Reference

1. Caminal JM, Lorenzo D, Gutierrez C, et al. Local resection in choroidal melanoma: a review. J Clin Med 2022;11:7156; https://doi.org/10.3390/jcm11237156