Table of contents
Uveal melanoma
What's new
Updated 2023 ASCO guidelines for the management of uveal melanoma.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of uveal melanoma are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2023), the Uveal Melanoma Consensus Group (UM-CG 2016), and the United Kingdom National Multidisciplinary Guidelines (UKNMG 2015).
1
2
3
Diagnostic investigations
Initial assessment
As per UM-CG 2016 guidelines:
Evaluate all intraocular malignancies and indeterminate lesions by a provider trained in all aspects of care (medical, oncologic, surgical, radiotherapy, and laser therapy) to determine the appropriate treatment, as observation with the subsequent delay in therapy (even in small intraocular malignancies with ≤ 2 mm thickness) can increase the risk of metastasis.
E
Obtain a complete ophthalmologic assessment of risk factors for future growth in patients with indeterminate lesions. Discuss with the patient about treatment, including the future risk of growth and metastasis balanced with the risk of visual loss from treatment, in the presence of risk factors.
E
More topics in this section
Imaging for staging
Laboratory tests
Diagnostic procedures
Medical management
Expectant management: as per UM-CG 2016 guidelines, do not offer observation in patients with uveal melanoma except in unique situations.
D
More topics in this section
Systemic therapy
Therapeutic procedures
Brachytherapy: as per UM-CG 2016 guidelines, offer brachytherapy in patients with high-risk indeterminate lesions and lesions < 10 mm in thickness and 18 mm in maximum diameter.
E
Show 2 more
More topics in this section
Transpupillary thermotherapy
Surgical interventions
Indications for surgery
As per UM-CG 2016 guidelines:
Reserve enucleation for lesions > 10 mm in thickness or 18 mm in diameter (or both) because of complications secondary to radiation, including the risk of severe vision loss and loss of the eye.
E
Consider performing excision (iridocyclectomy and iridectomy) for selected ciliary body and iris lesions.
E
More topics in this section
Resection of metastases
Patient education
Follow-up and surveillance
Follow-up
As per UM-CG 2016 guidelines:
Obtain an annual liver ultrasound and perform a physical examination indefinitely in low-risk patients (gene-expression profiling class 1a or 1b, no monosomy 3 detected, or tumor < 9 mm thick and no genetic assessment). Consider transitioning follow-up to the family physician at 5 years.
E
Perform an annual physical examination indefinitely and obtain imaging every 6 months (consisting of liver ultrasound alternating with abdominal or liver MRI; consider obtaining other modalities if the body habitus limits ultrasound) for 10 years in high-risk patients (gene-expression profiling class 2, monosomy 3 detected, or tumor ≥ 9 mm thick and no genetic assessment). Consider transitioning follow-up to the family physician at 5-10 years.
E