The pros and cons of local resection of choroidal melanoma

Resection of choroidal tumors is a treatment option but it is technically challenging and more challenging than removing tumors in the iris and ciliary body because the choroid is less accessible.

In a review of the literature on surgical procedures to remove choroidal tumors via endoresection (ab interno) or transscleral resection (ab externo), Spanish investigators found that local resection may offer better visual results and eye sparing without compromising local tumor control and survival, but there are come caveats attached,1 according to lead author Josep Maria Caminal, MD, from the Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain.

The investigators used the PubMed database of the U.S. National Library of Medicine and the Cochrane Central Register of Controlled Trials of the Cochrane Library to compare the 2 methods of choroidal tumor excision for visual outcomes, survival rates, and complications.

Twenty-five studies met the inclusion criteria; 12 studies described exoresection (6 retrospective studies and 6 comparative studies) and 13 described endoresection (11 retrospective and 2 comparative studies).

The investigators reported that both surgeries are indicated to remove large tumors with thicknesses exceeding 8 mm with small base diameters. In addition to eliminating the risk associated with radiotherapy, surgery provides clinicians the opportunity to obtain histopathologic and cytogenetic data from surgical specimens. However, both surgeries are challenging and carry the risk of severe early and late postoperative complications.

Caminal and colleagues provided several key points.

“Choroidal tumor resection is an alternative to brachytherapy in selected cases,” Caminal said. “The available data suggest that this approach may offer better visual results and eye sparing without compromising local tumor control and survival.”

Investigators also noted that sesection techniques for choroidal tumors are based on modern vitreoretinal surgical techniques, which allow for the treatment of more challenging cases.

The main limitations to surgical resection of these tumors are the risk of severe complications, which may include retinal detachment, proliferative vitreoretinopathy, severe intraoperative hemorrhage, air embolism, and local tumor recurrence at the resection edge.

Surgical resection of uveal melanomas should be limited to centers with substantial experience in the management of intraocular tumors,” investigators concluded.

Reference

Caminal JM, Lorenzo D, Gutierrez C, et al. Local resection in choroidal melanoma: a review. J Clin Med 2022;11:7156; https://doi.org/10.3390/jcm11237156