Melanoma - Radioactive Plaque Surgical Placement for Choroidal Melanoma
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78-year-old man has a large choroidal nevus or a small melanoma in the left eye. I have been following this since October of 2005. He was fairly certain that this nevus was noted in the 1980’s by his ophthalmologist. However, try as we may, we have not obtained any old charts, and it sounds like the visit was so long ago that the charts from that period no longer exist. His vision is doing fine.
VISUAL ACUITY: OD: 20/20; OS: 20/25. IOP: OU: 15. There is 2+ nuclear
sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OS: C/D ratio is 0.3. There is an 8 x 10 millimeter choroidal nevus and the superotemporal quadrant stops just a disc diameter short of the fovea.
Ultrasound shows the nevus to be 3.7 millimeters elevated.
IMPRESSION:
1. SUBSTANTIALLY GROWING MELANOMA IN THE LEFT EYE.
DISCUSSION: I showed the patient the ultrasounds and explained to him that at this point, given the orange pigmentation, the growth, the size and the characteristics, this is a medium-sized melanoma and not a choroidal nevus. I think, despite the long history of a lesion in that eye, it should be treated with a radioactive plaque. He is going to think about this. He is not certain he wants to go ahead with the plaquing. I explained to him that melanomas do grow slowly, but they can be fatal if left untreated, and suggested that we go ahead with plaque therapy. He has plans for May and June, and since this
probably has been in the eye for years and years, I think a few months will not make any substantial difference. I told him that I would recommend plaquing right away, but if he wants to wait until July until his plans are through, I do not think that is unreasonable. I scheduled him to return here for a check in a few months, at which point I will re-measure the tumor and set him up for a radioactive plaque placement. I told him I would be happy to refer him to a tumor center if he would like a second opinion. This tumor is close enough to the fovea that he may end up with radiation retinopathy and vision problems. Thank you again for referring this pleasant patient.
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78-year-old man has a large choroidal nevus or a small melanoma in the left eye. I have been following this since October of 2005. He was fairly certain that this nevus was noted in the 1980’s by his ophthalmologist. However, try as we may, we have not obtained any old charts, and it sounds like the visit was so long ago that the charts from that period no longer exist. His vision is doing fine.
VISUAL ACUITY: OD: 20/20; OS: 20/25. IOP: OU: 15. There is 2+ nuclear
sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OS: C/D ratio is 0.3. There is an 8 x 10 millimeter choroidal nevus and the superotemporal quadrant stops just a disc diameter short of the fovea.
Ultrasound shows the nevus to be 3.7 millimeters elevated.
IMPRESSION:
1. SUBSTANTIALLY GROWING MELANOMA IN THE LEFT EYE.
DISCUSSION: I showed the patient the ultrasounds and explained to him that at this point, given the orange pigmentation, the growth, the size and the characteristics, this is a medium-sized melanoma and not a choroidal nevus. I think, despite the long history of a lesion in that eye, it should be treated with a radioactive plaque. He is going to think about this. He is not certain he wants to go ahead with the plaquing. I explained to him that melanomas do grow slowly, but they can be fatal if left untreated, and suggested that we go ahead with plaque therapy. He has plans for May and June, and since this
probably has been in the eye for years and years, I think a few months will not make any substantial difference. I told him that I would recommend plaquing right away, but if he wants to wait until July until his plans are through, I do not think that is unreasonable. I scheduled him to return here for a check in a few months, at which point I will re-measure the tumor and set him up for a radioactive plaque placement. I told him I would be happy to refer him to a tumor center if he would like a second opinion. This tumor is close enough to the fovea that he may end up with radiation retinopathy and vision problems. Thank you again for referring this pleasant patient.
