md-medicaldata

Authors

 

Jelena Miljković¹, Dragan Veselinović<sup>2

1</sup>Dom zdravlja Niš
²Klinika za očne bolesti KC Niš

 

The paper was received on 29.03.2017. / Accepted on 22.04.2017

 

Correspondence to

Dr Jelena Miljković
Dom zdravlja Niš
Ul. Vojvode Tankosića 15
18000 Niš
Tel: 064/561-13-61
e-mail: : jelenakocic4@gmail.com

 

 

Abstract

 

Melanoma is a malignant tumor arising from the pigment cells (melanocytes) and may originate from the skin, the eye and tissues surrounding the eye or the mucosa. Uveal melanoma is the most common primary intraocular malignancy in adults. In following presentation we report a case of a female patient, who had her regular ophthalmologic checkup which showed choroidal mass in the right eye, diagnosed as a choroidal melanoma. Considering the fact that it’s her only functional eye, it was desides to conserve the eyeball, and to start brachytherapy , using Ru-106 plaques. 4 years after brachytherapy the progression of the lesion was detected, and it was treated with proton beam therapy. During the 7-years follow up period metastatic disease was not diagnosed. Our patient maintained adequate visual acuity and there was no serious treatment-related ocular side effect. Age is the only proven risk factor for choroidal melanoma. Caution is required if a person has light iris color, is sensitive to ultraviolet light, or has a dysplastic nevus syndrome. Patients with choroidal nevi should be involved in a follow-up programe, just as those with hereditary cancer syndrome. If melanoma of the eye is diagnosed at eary stage optimal therapy options can be administrated. But, developments in treatment methods (radiotherapy) and increasing tendency toward eye-sparing therapies over the last 30 years, survival rates have remained constant, due to metastatic disease. The efficacy of systemic treatment could be improved with adjuvant immunotherapy and biologic therapy that target micrometastases instead of macrometastases.

 

 

 

Key words:

eye, uvea, choroidal melanoma, radiotherapy.

 

 

Sažetak

 

Melanom je maligni tumor koji nastaje iz pigmentnih ćelija (melanocita) i može se javiti u koži, oku i adneksama ili mukozi. Melanom uvee je najčešći primarni maligni intraokularni tumor kod odraslih. U radu je prikazan slučaj pacijentkinje kojoj je na redovnom oftalmološkom pregledu uočeno postojanje tumorskog čvora na sudovnjači desnog oka, dijagnostikovan kao melanom horoidee. S obzirom da je to njeno jedino funkcionalno oko, odlučeno je da se očna jabučica sačuva, tj. da se pristupi radioterapiji. Pacijentkinja je prvobitno bila podvrgnuta kontaktnoj zračnoj terapiji uz pomoć pločica prevučenih rutenijumom. Nakon 4 godine od zračenja registrovana je progresija lezije, za koju je odlučeno da se tretira usmerenim snopom protona visoke energije. U toku 7-ogodišnjeg praćenja nije registrovana pojava udaljenih metastaza. Obezbeđena je dobra vidna funkcija obolelog oka, bez razvoja značajnih sekundarnih promena. Životno doba je za sada jedini dokazani faktor rizika za ovaj maligni tumor. Potreban je oprez kod osoba svetle kože i svetle boje irisa, osoba osetljivih na UV zračenje i onih sa prisutnim displastičnim nevusima na koži, kao i praćenje kod pacijenata sa horoidalnim nevusima i onih kod kojih postoje nasledni tipovi kancera u porodici. Melanomi oka, otkriveni u ranim stadijumima imaju dobre mogućnosti za lečenje. Iako se radioterapija danas preferira kao inicijalni tretman nasuprot enukleaciji obolelog oka, stopa preživljavanja u proteklih 30 godina ostaje na istom nivou zbog pojave metastaza. Radi se na razvoju imunološke i biološke (ciljane) terapije koja će moći da prevenira progresiju mikrometastaza.

 

 

Ključne reči:

oko, uvea, melanom horoidee, radioterapija

 

 

References

 

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PDF Miljković J. and Veselinović D. MD-Medical Data 2017;9(2): 117-122