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2016, Volume 32, Number 3, Page(s) 186-192     
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DOI: 10.5146/tjpath.2015.01357
Management and Outcome of Uveal Melanoma in a Single Tertiary Cancer Center in Jordan
Ahmed ZEWAR1, Ibrahim NAWAİSEH1, Imad JARADAT2, Jakub KHZOUZ3, Khaleel ALRAWASHDEH1, Ghadeer ABDEEN4, Mustafa MEHYAR1, Samer KHURMA1, Yacoub A YOUSEF1
1Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman, Jordan
2Departments of Radiotherapy, King Hussein Cancer Centre (KHCC), Amman, Jordan
3Departments of Pathology, King Hussein Cancer Centre (KHCC), Amman, Jordan
4Departments of Medical Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
Keywords: Choroid, Enucleation, Melanoma, Radioactive plaque therapy

Objective: The aim of this study was evaluate the features and outcome of management of uveal melanoma in King Hussein Cancer Center as an example of a referral tertiary cancer center in the Middle East.

Material and Method: This was aetrospective, observational case series of 46 eyes of 46 patients with uveal melanoma. Data collection required access to medical records, radiology and pathology reports, and laboratory results. The main outcome measures included age at diagnosis, tumor location and dimensions, TNM stage, treatment modality, visual outcome, metastasis, and mortality.

Results: There was slight female preference, and the median age at diagnosis was 45 years. Eighteen (39%) eyes were treated by primary enucleation, and 28 (61%) eyes were treated by I-125 radioactive plaque. The melanoma was in the choroid in 40 (87%) eyes and in the ciliary body in 6 (13%) eyes, with no single tumor in the iris. According to the 7th edition of the American Joint Committee on Cancer staging system (UICC/AJCC); 8 (17%) were T1, 17 (36%) were T2, 16 (35%) were T3, and 5 (11%) were T4. One (2%) patient showed lymph node metastasis (N1), and 6 (13%) patients showed distant metastasis (M1). Pathologically, 2 (10%) of the enucleated eyes were spindle cell type, 4 (20%) were epithelioid cell type, and 14 (70%) were mixed type. Extrascleral extension was seen in three (15%) eyes, and optic nerve invasion in two (10%) eyes. After brachytherapy, 26 (93%) eyes were salvaged, and 2 eyes were consecutively enucleated; one for tumor recurrence, and one for uncontrolled painful neovascular glaucoma. The eye salvage rate post plaque was 93% (26/28), and the visual acuity for the salvaged eyes was equal or better than 0.5 in 11 (42%) eyes, 0.1-0.4 in 5 (19%) eyes, and less than 0.1 in 10 (38%) eyes.

Conclusion: The incidence of uveal melanomas in our region is low compared to that in the West with a younger age at presentation. Candidate tumors for radioactive plaque therapy were successfully controlled in 93% of cases

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