FROM THE INSIDE OUT
OR FROM THE OUTSIDE IN -
RESECTION OF UVEAL MELANOMA

Norbert Bornfeld, G. Horstmann, H. Schilling, S. Tallies, G. Anastassiou (Essen)

Eye salvaging therapy of large uveal melanomas has a high incidence of complications including long standing retinal detachment and secondary glaucoma eventually leading to at least functional loss of the tumor-containing eye. As in other tumors resection of a large melanoma should have the better chances for organ preservation if technically feasible. Two techniques (transscleral resection or resection of the tumor using a transretinal pars plana approach) are available to surgically remove a large uveal melanoma. Based on a series of more than 70 tumors removed from a transscleral approach and 20 tumors removed by endoresection indications, complications, limitations and potential pitfalls are shown. None of the techniques may ever be used without ancillary radiotherapy as in particular endoresection has a considerable risk of disseminating viable tumor cells outside the eye and potentially outside the orbit. Based on the clinical results best indications for transscleral resection are large tumors not exceeding 15 mm in basal diameter in the nasal periphery. Best indications for endoresection are high tumors with 10 mm or less in basal diameter located in the midperiphery of the fundus.


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