Clinical features and management of iris melanoma - a systematic review

Abstract

Introduction and purpose 

Uveal melanoma is the most common primary intraocular malignancy in adults. Most of them arise in the choroid and ciliary body, whereas 2-5 % of the cases are located to the iris. Nevertheless, during the last few decades the incidence of this neoplasm has been increasing. The aim of the study is to discuss the risk factors, clinical features and methods of diagnosis and treatment of iris melanoma. 

Description of the state of knowledge 

Iris melanomas vary in their shape, size, degree of pigmentation and clinical behavior and most commonly present as a nodular tumor located in the lower temporal iris quadrant. This localisation is linked to exposure to solar radiation, which among light-colored iris, skin color and pre- existing iris naevus, is a risk factor for this malignancy. Gender predilection for the development of iris melanoma is unclear, however, some studies indicate a predominance of female patients. The most common clinical symptoms are growth of a pre-existing naevus, detection of new, dark lesion, pain secondary to elevated IOP and blurred vision. Due to anterior location of this site of uvea, early diagnosis and treatment is possible. Slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (UBM) allow staging of the tumor to guide the most appropriate treatment. As many primary iris lesions have a benign prognosis, surgical resection or radiotherapy is efficient way of treatment and allows good local tumor control.  

Summary 

Iris melanoma is least frequent of all uveal melanomas and usually presents as variably pigmented, elevated, solitary lesion. When there is a clinical suspicion of malignancy slit- lamp examination and UBM should be performed. When early diagnosed it can be successfully treated.