Malignant melanoma of the uvea: Surgical techniques

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Uveal melanoma can be excised by local resection or enucleation. Local resection comprises trans-scleral ‘exoresection’ and trans-retinal ‘endoresection’. Variations of exoresection include: iridectomy; irido-cyclectomy; cyclo-choroidectomy and choroidectomy. Resection of melanomas involving ciliary body and/or choroid is usually followed by adjunctive brachytherapy, which is administered immediately after the excision procedure or several weeks later, once the eye has healed.Such adjunctive radiotherapy prevents local recurrence while avoiding the need for wide safety margins, thereby reducing ocular morbidity. Endoresection is performed through a retinotomy over the tumour or after raising a retinal flap. Enucleation is undertaken in the conventional manner, using the surgeon's preferred implant. Primary local resection is performed when radiotherapy is likely to cause excessive morbidity, because of large tumour size or proximity to the optic disc. Secondary resection is undertaken as a treatment for local tumour recurrence or the toxic tumour syndrome after radiotherapy. Surgical resection provides ample tumor material for diagnosis and prognostication, which may in future be useful therapeutically.

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