Primary iris melanoma: diagnostic features and outcome of conservative surgical treatment

Aims-To describe features influencing the management of primary iris melano ma and report the outcome of conservative surgical treatment of patients di agnosed with this condition in a tertiary referral academic setting over a 20 year period. Methods-Retrospective non-comparative case series of consecutive patients d iagnosed with iris melanoma from 1980-2000 using medical records from the U niversity of Sydney Department of Ophthalmology and NSW Cancer Registry Results-51 cases were identified. The most common presentation was growth o f a previously noted pigmented lesion. Initial management was either observ ation or local resection (two had enucleations) with iris reconstruction wh ere possible (23.8%). The mean follow up was 8.7 years (range 1-17 years). Vision of 6/12 or better was maintained in the majority (78.6%) treated by local resection. Pupil reconstruction significantly reduced reported postop erative glare symptoms. Four patients had features suggestive of local recu rrence and there was no documented metastatic disease or death from iris me lanoma in this series. Histologically, the majority were spindle B cell mel anomas. Clinical features including prominent tumour vascularity, rapid gro wth, and heterogeneous pigmentation were each significantly associated with an epithelioid cell component. Involvement of the iridocorneal angle was f requently associated with ciliary body invasion. Conclusions-Management decisions for iris melanoma will depend on the clini cal features. Mixed or epithelioid histology is more likely in the presence of two or more of the features of malignancy and may justify earlier inter vention. When treatment is undertaken, local resection achieves long term t umour clearance with an acceptable morbidity. In resecting iris melanoma, c areful assessment for iridocorneal angle involvement is important in treatm ent planning. Iris reconstruction has a useful role in reducing postoperati ve photophobia.