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Choroidal Melanoma Brachytherapy

Eye-sparing radiotherapy with plaque brachytherapy

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Choroidal Melanoma Brachytherapy?

Choroidal melanoma is the most common primary intraocular malignancy in adults, arising from melanocytes in the choroid layer. Plaque brachytherapy is the gold-standard eye-conserving therapy for small-to-medium choroidal melanomas (apical height up to 10 mm and basal diameter up to 18 mm), delivering 85 Gy to the tumor apex over 4-7 days through a radioactive plaque sutured directly to the sclera over the tumor base.

Iodine-125 (low-dose-rate, gamma) is the most widely used isotope worldwide, while ruthenium-106 (beta) is preferred for thinner tumors due to its rapid dose fall-off. The Collaborative Ocular Melanoma Study (COMS) trial demonstrated equivalent overall survival between brachytherapy and enucleation for medium-size tumors, establishing eye preservation as standard care.

Treatment requires multidisciplinary planning including ocular oncology, radiation oncology, and medical physics for plaque design, dosimetry calculation, and surgical placement. Long-term follow-up monitors local recurrence, radiation retinopathy, optic neuropathy, cataract, neovascular glaucoma, and systemic metastasis (primarily hepatic).

Symptoms

Painless visual loss or blurring
Visual field defect (scotoma)
Photopsia (flashes of light)
Floaters from vitreous hemorrhage
Subtle metamorphopsia (distorted vision)
Pigmented or amelanotic fundus lesion
Retinal detachment overlying tumor
Lipofuscin deposits (orange pigment)
Drusen and retinal pigment epithelium changes
Often asymptomatic and detected on routine examination
Iris or ciliary body involvement may cause hyphema
Late-stage: pain from neovascular glaucoma
Systemic symptoms only with metastatic disease
Unexplained weight loss in metastatic stage
Right upper quadrant pain in hepatic metastasis

Risk Factors

Light iris color (blue, green, hazel)
Fair skin (Fitzpatrick type I-II)
Northern European ancestry
Choroidal nevus (precursor lesion in some cases)
Ocular or oculodermal melanocytosis (nevus of Ota)
Dysplastic nevus syndrome (rare association)
BAP1 tumor predisposition syndrome
Chronic ultraviolet light exposure (controversial)
Welding occupational exposure
Previous cutaneous melanoma (rare)
Family history of uveal melanoma
Age over 50 years
Male sex (slight predominance)
GNAQ/GNA11 driver mutations (acquired)
Chromosome 3 monosomy and class 2 gene expression profile (predict metastasis)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New visual loss or scotoma in one eye
  • Photopsia or floaters
  • Pigmented fundus lesion identified on routine eye examination
  • Choroidal nevus with documented growth
  • Choroidal nevus with subretinal fluid, orange pigment, or thickness over 2 mm
  • Retinal detachment without rhegmatogenous cause
  • Recurrent vitreous hemorrhage
  • Family history of uveal melanoma with new symptoms
  • Suspicious lesion seen on ophthalmoscopy
  • Personal history of cutaneous melanoma
  • Iris pigmented lesion with growth
  • Asymmetric ocular pigmentation

Treatment Methods

01
Comprehensive ocular oncology evaluation with dilated fundus examination, fundus photography, ultrasound (B-scan and standardized A-scan), and optical coherence tomography
02
Fluorescein and indocyanine green angiography to assess vascularity
03
Wide-field fundus autofluorescence
04
Anterior segment imaging if iris/ciliary body involvement
05
Liver function tests, liver MRI or ultrasound, and chest imaging for metastatic workup
06
Genetic testing of tumor (chromosome 3 status, gene expression profile class 1 vs 2) via fine-needle aspiration biopsy at time of plaque placement for prognostic stratification
07
Multidisciplinary plaque design with radiation oncology and medical physics
08
Iodine-125 plaque for tumors up to 10 mm height (most common)
09
Ruthenium-106 plaque for thinner tumors (up to 5-6 mm)
10
Surgical placement under general or local anesthesia with extraocular muscle disinsertion if needed
11
Plaque dwell time 4-7 days delivering 85 Gy to tumor apex
12
Plaque removal as second surgical procedure
13
Anti-VEGF intravitreal injections for radiation maculopathy and neovascular complications
14
Periodic intravitreal triamcinolone or sustained-release dexamethasone implant for radiation retinopathy
15
Photocoagulation or transpupillary thermotherapy for residual tumor activity (rarely)
16
Cataract surgery for radiation-induced lens opacity
17
Glaucoma management for neovascular glaucoma (anti-VEGF, panretinal photocoagulation, glaucoma drainage device, cyclodestruction)
18
Enucleation for treatment failure, intractable pain, or large recurrence
19
Lifelong systemic surveillance with biannual liver imaging and annual chest imaging for at least 10-15 years
20
Adjuvant systemic therapy under investigation for high-risk class 2 tumors
21
Tebentafusp (bispecific T-cell engager) for HLA-A*02:01 positive metastatic disease
22
Clinical trials for adjuvant immunotherapy in high-risk patients

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.