Choroidal melanoma: clinical presentation and differential diagnosis

Detecting Early Ocular Choroidal Melanoma Using Ultrasound Localization Microscopy

Ocular choroidal melanoma (OCM) is the most common ocular primary malignant tumor in adults, and there is an increasing emphasis on its early detection and treatment worldwide. The main obstacle in early detection of OCM is its overlapping clinical features with benign choroidal nevus. Thus, we propose ultrasound localization microscopy (ULM) based on the image deconvolution algorithm to assist the diagnosis of small OCM in early stages. Furthermore, we develop ultrasound (US) plane wave imaging based on three-frame difference algorithm to guide the placement of the probe on the field of view. A high-frequency Verasonics Vantage system and an L22-14v linear array transducer were used to perform experiments on both custom-made modules in vitro and a SD rat with ocular choroidal melanoma in vivo. The results demonstrate that our proposed deconvolution method implement more robust microbubble (MB) localization, reconstruction of microvasculature network in a finer grid and more precise flow velocity estimation. The excellent performance of US plane wave imaging was successfully validated on the flow phantom and in an in vivo OCM model. In the future, the super-resolution ULM, a critical complementary imaging modality, can provide doctors with conclusive suggestions for early diagnosis of OCM, which is significant for the treatment and prognosis of patients.

Uveal melanoma: Ocular and systemic disease

Although rare, uveal melanoma is the most common intraocular tumor in adults. Most cases arise from the choroidal layer of the uvea, displaying a discoid, collar-button, or mushroom shaped growth. Histopathologically, neoplasms are classified by the dominant cell type: spindle, epithelioid or mixed spindle cell type. The most important prognostic factors are cell type, nucleolar size, largest tumor dimension, and mitotic figures. Patient prognosis is poor when metastases occur in the liver, one of the main reasons that despite advances in the diagnosis and treatment of uveal melanoma, the mortality rate has not change significantly since 1973.

The impact of diagnosis and plaque radiotherapy treatment of malignant choroidal melanoma on patients' quality of life

Quality of life (QOL) has become an important outcome criterion of medical interventions, but the impact of diagnosis and radiotherapy on QOL in patients with malignant choroidal melanoma (MCM) has rarely been studied. Inventories covering global (SF-36) and disease-specific QOL (NEI-VFQ), mental distress (SCL-90-R), and social support (K-22, German) were applied to a consecutive sample of MCM-patients scheduled for plaque radiotherapy. Data were gathered preoperatively (t(0)) and 3 months postoperatively (t(1), except for the K-22, which was applied at t(0) only). Fifty-four patients took part in both surveys, the number of patients with visual impairment increased from 21 preoperatively to 34 postoperatively. Global QOL of MCM-patients was significantly reduced compared to the healthy norm and other ophthalmological patients both at t(0) and t(1). Clinically relevant distress was present in every second patient at t(0) and every third patient at t(1), social support was not impaired. Global and disease-specific QOL declined significantly from t(1) to t(0). The MCM diagnosis compromises QOL, which is additionally impaired by radiotherapy. Regular QOL assessment can help to identify patients at risk, facilitate provision of psychosocial treatment and may thus improve patient satisfaction.